First Name
:
*
Last Name
:
Email
:
*
Phone Number
:
*
What are your goals?
:
Lose weight
Improve stamina
Revalidation
Increase strength
Feel better about myself
Other
If 'Other', please elaborate
:
What is the deadline for your goal(s)?
:
3 months
6 months
12 months
As long as it takes
How important is reaching your goal(s) for you?
:
1
2
3
4
5
How long have you thought about starting Fitness?
:
Please Choose
Shorter than a month
1 to 6 months
6 months or more
Wil je afvallen? Zo ja, hoeveel kg?
:
Have you done any Fitness before?
:
Yes
No
Are you already a member?
:
Yes
No
Check agreement
:
*
I’m okay with the safe storage of my personal information for approaching me with (start)information and updates (mandatory)
Source
:
Source
: