Program Registration (Online payment below)

First & Last name:

Street Address::

City::

Postal Code: :

Phone number :

Email address:

Location/Program:
Baden Boot Camp - 6 am
Dearborn - mornings (M/W/F)
Equestrian Fitness
TRX at Kick 'n Sport - 6:15 am
Wellesley Boot Camp

Which program package?:
4 week program
6 month Boot Camp program
Bridal Boot Camp

I recruited a camper for the 6 month special:
yes
no

If yes...their name is:

If yes...their name(s) is/are:

Any medical conditions we should be aware of? :
yes
no

Emergency Contact: :

Emergency contact phone number: :

To improve my results, I would like to purchase a Nutritional Kit for $39.95 :
yes
no

I would like 2 Boot Camp online workouts a month for only $24.95? (demonstrated via animation):
yes
no

Method of payment: :
Cash (due on start date)
Cheque (due on start date)
Online (a processing fee applies)

How did you hear about Energy for Life Fitness programs?:

Please type the text below: