Cyclist Profile & Package Registration

1. Please complete the following questionnaire as completely and honestly as possible. It will help us determine the best strategy for planning your performance training.
2. Name:(*)
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3. Age:(*)
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4. Sex:(*)
   MaleFemale
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   Indicate your sex
5. Address:(*)
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   Enter your street address
6. City:(*)
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   Enter your city
7. Province:(*)
   ABBCSKMBONPQNBNLPEYTNTNUNS
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   Choose your province
8. Postal Code:(*)
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   Enter your postal code
9. Home Phone:
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   Enter your home phone number
10. Business Phone:
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    Enter your business phone number
11. Mobile Phone:
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    Enter your mobile phone number
12. email:(*)
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1. Did you complete any type of strength training during the last season?
   YesNo
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2. Explain:
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3. Package(*)
   Gold ($340.00/mo.)Silver ($175.00/mo. + $175.00 initiation)Bronze ($115.00/mo. + $210.00 initiation)
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4. Additional Services
   Nutrition Assessment
   Group Computrainer Ride (1 per week)
   Group Weight Session (1 per week)
   Group Weight Sessions (2 per week)
   
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   Group workouts are included in the Gold pacakge. Silver package participants receive a 15% discount on group workouts.
5. Additional Comments:
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6. Are you sure you are human?
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