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Fitcamp Challenge Application Form
Please fill the form carefully
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Step 1
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Step 2
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Step 3
PLEASE NOTE: MISSING ORIENTATION without a valid reason WILL DISQUALIFY YOU.
*
Full Name:
*
First Name
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Last Name
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Mobile No:
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The value must be less than or equal to 20
Email id:
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Please enter valid email address
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Date of Birth:
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The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
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Age:
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The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Address:
Address Line1
Address Line2
Land Mark
City
State
Country
Please select country name
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Congo {Democratic Rep}
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland {Republic}
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar, {Burma}
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
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Zip Code
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Gender:
Male
Female
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Medical Conditions :
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*
Where did you hear about the Fitcamp Challenge:
Facebook
Flyer
Family
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In order for us to find out what your Goals are, please specify below what you are expecting from this challenge, and why?
*
How fit do you think you are:
Couch Potato...Standing up is optional
I'm moderately fit...I think
Total Fitness Buff! Where are my dumbells
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*
I want to improve in the following areas:
I'd like to lose overall weight
I need to lose body fat to show off my muscles
I want to build lean muscles
I just want to get fit
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Are you currently on any Nutritional or Meal Replacement programme which you intend to use in Conjuction with this 4-week challenge:
None
USN
Evox
Weigh Less
Herbalife
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Please list 3 friends or family who you think would benefit from joining you for this 4-week challenge.
Friend Name 1:
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Contact Number:
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Invalid phone number.
The value must be less than or equal to 20
Friend Name 2:
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Contact Number:
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Invalid phone number.
The value must be less than or equal to 20
Friend Name 3:
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Contact Number:
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Invalid phone number.
The value must be less than or equal to 20
Would you be interested in:
Beach Workout
Hikes
Both
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I agree to terms & conditions
I agree to terms & conditions
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