Let’s Get Started Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Phone(Required)Fitness Level(Required) Beginner Intermediate Advanced What do you hope to gain from the program?(Required)Additional CommentsWhich Program are you signing up for?(Required)Holistic Fitness ($20/month)1:1 Virtual, Holistic Fitness Training ($100/month)6 Week Holistic Fitness Training ($150/6 weeks)Liability WaiverPlease review the Liability Waiver (click here).Liability Waiver Confirmation(Required) I have read and accept the liability waiverSignature(Required)Your signature represents your acceptance of the liability waiver. Total The total amount displayed here will be automatically charged to your card every month for the Holistic Fitness and 1:1 Virtual Training programs, or every 6 weeks for the 6 Week Holistic Fitness Training program. You may cancel your subscription at any time. Credit CardCard Details Cardholder Name Δ
