Bootcamp Registration Form - Surrey Langley BC

First Name*

E-mail:*

Address:*

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Last name:*

Phone Number*

Area Code

-

Phone Number

Date of birth:*

/

day

month

year

What Are Your Primary Fitness Goals?*

Referred by

Is this your first bootcamp?*

Yes

No

I am interested in these days and times:*

I would like to register for this time if available*

I would like to participate in:*

1 Session Per Week For 1 Month $89+GST

2 Sessions Per Week For 1 Month $149+GST

Drop In Fee $25+GST

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