"FIT IN 3 MONTHS" Registration
REGISTER NOW FOR A NEW, HAPPY AND HEALTHY LIFE
Your Name *
Your Age in Years *
Your Gender *
Options Male Female
Your Email ID *
Please furnish your current and valid address to
keep receiving updates and communication.
Your Mobile Number *
Your present Address *
Which is your preferred language ? *
Options English Hindi Tamil Telugu Other
Your current weight range (Kgs) *
Options <41 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 91-95 96-100 1001-110 111-120 121-130 131-140 141-150 >150
Your current Height (Inches) *
Options <60 60 61 62 63 64 65 66 67 68 69 70 71 72 >72
Are you suffering from any present Illness ? If
so, give details. Also give details of your PAST
Illness, if any *
Which of the following Equipment you have at home
? *
Options Treadmill Cross Trainer Exercise Bike Home Gym Dumbbells/Bar Bells Elastic Exercise Bands/Ankle Weights Others Nothing at all
How often do you Exercise ? *
Options Never One time a week Two times a week Three times a week Four times a week Five times a week
What sort of guidance do you require from us ? *
Options (1) Help in selection of appropriate fitness equipment for my home (2) Help in selection of appropriate fitness equipment for a GYM / Fitness Studio (3) Consultation for tailor made Training Program (4) Enroll in the "FIT IN 3 MONTHS' Program (5) Weight LOSS Program (6) Weight GAIN Program (7) Bridal Fitness Program (8) Consultation for setting up a GYM Center (9) None
If you wish to Enroll in the "FIT IN 3 MONTHS"
Program, which one of these would you prefer ?
(No
obligation to purchase now) *
Options (1) Just the fitness guide "FIT IN 3 MONTHS" (Cost INR 300/- or USD 7.00) (2) No.(1) above + 3 months Email Support (Cost INR 1800/- or USD 42.00) (3) No.(1) above + 3 months Online Web Cam Support(Cost INR 3300/- or USD 77.00)
Which time frame is convenient for Online Web Cam
Support ? *
Options 5.00am to 6.00am 6.00am to 7.00am 7.00am to 8.00am 8.00am to 9.00am 6.00pm to 7.00pm 7.00pm to 8.00pm 8.00pm to 9.00pm 9.00pm to 10.00pm
Upload a File containing your medical/clinical
report (1), if any
Upload a File containing your medical/clinical
report (2), if any
Upload your recent full length photograph (1), if
any
Upload your recent full length photograph (2), if
any
Image Verification