fitmixer® Boot Camp Registration Form

To complete your enrollment for the next fitmixer® Boot Camp, please fill out the form below. Note that all fields require input (except the website/blog field), and any answers to asterisked (*) questions will be made public to your fellow Boot Campers as part of your bio (see the current bio page, here).

Note: If you came to this page prior to purchasing the Boot Camp Kit, your registration will not be complete until the kit is purchased. Filling out this form without first purchasing the kit will not guarantee your spot in the next fitmixer® Boot Camp. Please visit http://fitmixer.com/boot-camp-registration to purchase the kit.

First Name *

Last Name *

Email *

Make your email address public to other Boot Campers ? *

YesNo

Phone Number *

City In Which You Live *

STATE *

Zip Code *

Current Age *

Current Height *

Current Weight (lbs) *

Goal Weight After 8 Weeks *

Long-term goal weight *

Activity Level *

Tell us what you do for exercise *

What do you do for a living? *

Why did you join Boot Camp? *

What’s a random fun fact about you? *

Have any words of encouragement for your fellow participants? *

Website

Anything else we should know? *

Who told you about the fitmixer Boot Camp? *

Flavor of slim you would like *

Flavor of protein you would like *