12 Week Transformation Program

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Email *

First and Last Name *

Birthday *

YYYY

Phone Number *

Gender:

Height:

Weight:

What results would you like to accomplish during your 12 Week Transformation Program?

Overall wellness

Weight loss

Toning

Rehabilitation

Specific goal in mind

Accountability + consistency

Need a program to follow

Learn the gym

Build strength

Are you currently a PURE gym member?

Yes

Have never been to PURE

Clear selection

Have you worked with a trainer in the past?

Yes

Clear selection

If yes, what worked well for you? What did you really like about it?

If no, what are your expectations?

Tell us what you struggle with most?

Current activity level

Nothing at all

Extremely active

Clear selection

Would you prefer to have your 1:1 sessions in the gym or our private training studio?

Gym

Studio

Either/Both

Clear selection

Do you have any injuries or health concerns that we should know about? Please describe.

Select which package:

Package 1 $1299

Package 2 include the unlimited class pass $1499

Clear selection

Preferred start date:

YYYY

*Please note we have a 12 hour cancellation policy. If you cannot make it to your session please let your trainer know prior to 12 hours in advance. *

I understand.

You acknowledge and understand that we do not do refunds on any purchases. *no exceptions* *

I, understand.

We would love to know how you heard about our program? Were you referred by anyone, please let us know who.

Any additional comments or concerns? Please let us know.

Payment information:

Credit card 16 digits:

Expiration date (date/month):

Back 3 digits:

Address associated with the credit card you provided:

READY? Let's do this!!

Click submit and let's get started!

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