fitco 2 WEEK RAPID TRANSFORMATION PROGRAM

fitco 2 MINUTE APPLICATION form followed by payment.

All answers are strictly confidential including the essential medical questions.

All answers are required.

fitco Rapid One On One Batch Selection

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Start Date 30 September 2022

Thursday, 29 September 2022 - Application Deadline

Friday, 30 September 2022 - Orientation Week Start Date

Friday, 7 October 2022 - fitco TWO WEEK Rapid Transform Program Start Date

Monday, 24 October 2022 - End Program

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Start Date 28 October 2022

Thursday, 27 October 2022 - Application Deadline

Friday, 28 October 2022 - Orientation Week Start Date

Friday, 4 November 2022 - fitco TWO WEEK Rapid Transform Program Start Date

Monday, 21 November 2022 - End Program

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Start Date 25 November 2022

Thursday, 24 November 2022 - Application Deadline

Friday, 25 November 2022 - Orientation Week Start Date

Friday, 2 December 2022 - fitco TWO WEEK Rapid Transform Program Start Date

Monday, 19 December 2022 - End Program

Please select a fitco Rapid Start Date

fitco Rapid Start Date 30 September 2022 fitco Rapid Start Date 28 October 2022 fitco Rapid Start Date 25 November 2022

First Name

Last Name

Phone Prefix

Mobile Number

Address Line 1

Address Line 2

City

Province/State

Country

Postal Code

What is Your Age?

Sex

Are you pregnant or suspect that you are?

Yes No

What is your ethnicity?

White Black Hispanic Chinese Indian Other Asian Mixed Ethnicity

Are you?

Vegetarian Non-vegetarian Vegan Pescatarian Other

Do you have any specific dietary requirements or food allergies? (Enter "N/A" if not applicable)

Height in CM

Current Weight

Target Weight

What is your fitness level? (Rating of 1 - 4 with "4" being the highest)

1 2 3 4

What is your stress level? (Rating of 1 - 4 with "4" being the highest)

1 2 3 4

fitco can support me by improving my Physical, Mental and Emotional Balance by helping me to:

Lose weight and transform my shape Gain weight and transform my shape Maintain weight and transform my shape Relax and de-stress Understand myself better Understand others better Provide information about mental balance Understand my emotions better Understand others emotions better Provide information about emotional balance

Have you been diagnosed, received treatment for, or suspect you have any of the following major illnesses? (Select all that apply)

Anxiety Asthma Bipolar Mood Disorder Bone or Joint Disease, including Arthritis Cancer COPD (Emphysema, Chronic Bronchitis) Crohn's Disease Depression Diabetes Type 1 Diabetes Type 2 Disability Diverticulitis Eczema Epilepsy Fibromyalgia Gout Heart Disease Hepatitis High Blood Pressure (Hypertension) High Cholesterol HIV Inflammatory Bowl Disease Irritable Bowl Syndrome (IBS) Kidney Disease / Dysfunction / Stones Liver Disease / Dysfunction / Gallstones Lung Disease Mental Health Condition Migraines / Severe Headaches Muscular Condition / Spasms / Cramps Osteoarthritis Personality Disorder Physical Trauma Porphyria Psoriasis Recent Physiotherapy Schizophrenia Skin Condition Smoker Spastic COlon Thyroid Thyroid Disease Ulcerative Colitis Other Addictions Any Other Illness Not Applicable

If you have selected "any other illness" please specify. (Enter "N/A" if not applicable)

Has any of your family been diagnosed, received treatment for, or suspect you have any of the following major illnesses? (Select all that apply)

Does any of the following occur with regularity for you? (At least three times a week)

Eating faster than usual Eating past the the point of fullness Eating when not physically hungry Eating alone or in secret Feeling upset or guilty after overeating Feeling that you are abnormal Feeling "taken over" or "driven" as by an other presence in respect to eating Regurgitating what you have just eaten Hiding food instead of eating it Not Applicable

I am currently using the following medications: (Enter "N/A" if not applicable)

I have had the following surgeries: (Enter "N/A" if not applicable)

Which of the following activities do you perform? (Select all that apply)

Brush teeth at least once daily Eat at least 3 meals a day Shower/Bath daily Bowel Movement daily Drink 2 litres of water daily Sleep at least 7 hours every night Cook at home at least 4 days a week Work less than 10 hours a day Grooming myself, including dressing appropriately and brushing hair daily

In the last few years I have gained weight and/or become unfit because I: (Select all that apply)

Had a marriage or similar relationship beginning or ending Lost someone that was close to me Moved to a new home, city or country Am busier with family commitments Changes to work. i.e. Got a new job, changed employer or became unemployed Been pregnant Have started new chronic medications Have experienced a high level of stress Am busier with work commitments Have always been unfit since childhood Have been hormonal issues have experienced mental health issues Not Applicable

Select any that are true for you: (Select all that apply)

I have never been on a diet before I have previously been on a diet and lost a lot of weight I have previously been on a diet and not lost a lot of weight I have previously been on multiple diets and lost a lot of weight I have previously been on multiple diets and not lost a lot of weight I have never exercised before I have previously exercised and achieved a body transformation through a program I have always been fit and in good shape I have previously exercised and achieved a body transformation on my own I have always been in unacceptable weight and shape for my health I have always been in acceptable weight and shape for my health

I found out about fitco through:

The Founder A Friend Facebook Instagram Other

The full name of the person who referred me to fitcoNow (Enter "N/A" if not applicable)

I want to transform now with fitco because i want to: (Select all applicable)

Lose weight Improve my strength and muscle tone Change the way that I think Reduce the size of my stomach Change the way that I eat Optimizer and improve myself Make the most of my life Understand myself better Feel more balanced Feel more supported Feel less stressed and anxious All of the above

To achieve a bigger transformation, invite a friend "fitco Buddy" to complete the fitco Rapid Transformation Program with you. The name of my fitco Buddy is

My fitco Buddy's contact number

Please enter any promotional code:

I give fitco permission to use pictures and data I have submitted to the services for marketing purposes

With Identification (Pictures will contain face and names will be mentioned) Anonymously (Pictures will not contain face and names will not be mentioned)

I would like to receive the fitco newsletter containing information regarding the program, including new foods that can be consumed and fitco events that are taking place near me.

Yes No

I have read and agree to the fitco Terms & Conditions

I agree

I have read an agree to abide to the fitco Code of Conduct

I agree

I am interested to join the fitcoNow team through a well compensated part-time Motivational role and have read the requirements of the fitcoNow Motivator Opportunity.

Join Team

fitco 2 WEEK RAPID TRANSFORMATION PROGRAM

fitco Rapid One On One Batch Selection

Start Date 30 September 2022

Start Date 28 October 2022

Start Date 25 November 2022

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