21 Day Challenge Group Sampler Registration
RequiredRequired Question(s)
1.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:
Country:
Cell Number:

Required 2.

Have you participated in a health and fitness accountability or support group before?


Yes
No
  • Comment:

  • 500 characters left.
Required 3.

Do you currently have Beachbody on Demand?


Yes
No
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  • 500 characters left.
Required 4.
What do you hope to achieve by joining a group and finishing a program?  Please check all that apply.
Weight loss
Weight gain
Add lean tissue
Gain strength
Increased energy and stamina
Improve my health
Prevent disease and illness
Improve eating habits
Gain consistency with healthy behaviors
Better quality sleep
Learn how to be a better role model for my loved ones
Reduced stress
Change in body composition
Be in an environment that supports my health goals
Try something new
Learn how to follow a plan/program that meets my fitness goals
Other  
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Required 5.

How would you describe your current fitness level?

Low
Fair
High
  • Comment:

  • 500 characters left.
Required 6.

How would you describe your currently nutritional status?  (Please base your response on consistency over the past 6 months)

Poor (i.e., mostly processed foods, eat out multiple times per week, sugary beverages daily, very few whole foods)
Fair (i.e., eat mostly whole foods, some processed, eat several servings of fresh fruits and vegetable weekly, limit sugary beverages to 1 -2 times per week, eat out 1 - 2 times per week)
Good (i.e., eat mostly whole foods, rarely eat processed foods, eat several servings of fresh fruits and vegetables daily, focus on organic, grass fed and non-GMO, rarely eat out, never drink sugary beverages)
Other  
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  • 500 characters left.
Required 7.

Beachbody has a countless number of program combinations that will give you an idea of where you would like to start.  I have put together several 21 day "sampler" programs that will let you try a variety of types of trainings and trainers so that you can see not only what you like but what fits into your schedule right now.  Please select the one(s) that you are interested in hearinlg more about.

Beginner/Intermediate-
: Clean Week, 21 Day Fix (week 1), and A Little Obsessed
Intermediate/Advanced-
: Shaun T Week, Week of Hard Labor, and A Little More Obsessed
All Levels: LIIFT4 Sample Workouts, Shift Shop Prep Week, and A Little Obsessed
Enhanced Fitness Goals: Week 1 Insanity Max 30, LIIFT4 Sample Workouts, and Hammer Week 1
Mind Body: 3 Week Yoga Retreat and Tai Chen Phase 1
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Required 8.
What is the best way to reach you to discuss your responses?
email
Phone
Text
Other  
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  • 500 characters left.