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* 1. Name:

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* 2. Age:

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* 3. Gender:

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* 4. Interest:

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* 5. Goals:

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* 6. What is the best way to contact you, phone or email? Please provide information.

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* 7. Injury History & Any Current Injuries/Ailments:

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* 8. How many days a week do you plan to train?  (leave rest blank if interest is in PT sessions or in-person training)

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i We adjusted the number you entered based on the slider’s scale.

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* 9. Equipment you have access to: (leave blank if training sessions take place in BeStrongGym)

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* 10. Maxes: (leave blank if they do not pertain to your goals)

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