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Name * First Last
Phone Number * ### - ### - ####
Email *
Workout Partner Name First Last
Workout Partner Phone Number ### - ### - ####
I plan to attend the Kick-Off celebration Saturday, February 4th 7:00-9:30 a.m.
yes no
I plan to purchase the following plan at the Kick Off (See blog for details) *
"WE" Challenge Me Plan, $150 (This plan requires an additional purchase of an unlimited access monthly pass) "I" Challenge Me Plan, $150 (This plan requires the purchase of a one time $100 pass to attend weekly focus group & 4 Fuel the Flame Sessions)
IMPORTANT!
By typing my name in the space below, I understand I am signing my name electronically, and agree to all regulations outlined above, as well as in the challenge information guide. I am also releasing Jolie Hill, Avondale Academy, or any BE FIT instructor/therapist from any personal or business liability for any personal injury or difficulty sustained during the 12 week challenge from February 4, 2012 to May 4, 2012. * MM / DD / YYYY
Signature *
Do Not Fill This Out

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