8 Week Ab Fitness & Nutrition Program
8 week healthy body transformation program with Briana Michel. Results may air on a global TV Commercial.
First & Last Name *
Current Age *
Date of Birth (MM/DD/YY) *
Phone *
Email (be sure it is typed accurately) *
Height *
Current Weight *
Occupation *
# of Kids and Ages, if any
Weight Loss Goals (be specific - ideal weight, size, clearing up of health concerns, improvement of lifestyle, fitness goal, etc) *
List ALL Current Medications & Supplements (type N/A if you do not take anything) *
Do you have any of the following? *
Any Current Fitness Regimen? Please describe briefly
How would you describe your current eating?
Why do you want to participate in a public weight loss transformation? Why change now?
Any injuries or physical limitations? *
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