12-Week Build Challenge Registration

Next 12-Week Build challenge:

Name:

First Name

Last Name

Email:

Gender

Male

Female

Age:

Weight (kgs):

Height (cms):

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Current activity level

Do you have gym access?

Yes

If not, have you got any equipment at home?

Are there any foods you dislike?

Do you have any food allergies, intolerances or other dietary requirements?

Do you have any other illness or medical condition that needs to be accounted for?

Progress Photos

Would you be happy for us to share your transformation online?

Yes, that's fine

No, please keep private (not eligible for prizes)

How did you hear about Ash Mullen Fitness?

What is your friends full name who referred you?

Disclaimer

At Ash Mullen Fitness we believe you should consult your physician or other health care professional before starting this or any other fitness plan/program to determine if it is right for your needs. This is particularly true if you (or your family) have a history of high blood pressure or heart disease, if you have experienced chest pain when exercising or in the past month when not engaged in any physical activity, have high cholesterol, are obese, or have a bone or joint problem that could be made worse by a change in physical activity. Do not start this fitness plan/program if your physician or health care provider advises against it. If you experience faintness, dizziness, pain or shortness of breath at any time while exercising you should stop immediately. At Ash Mullen Fitness we offer health, fitness and nutritional information and recommendations that is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional. Do not disregard, avoid or delay obtaining medical or health related advice from your health-care professional because of something you may have read on your plan/program. Your plan/program has been customised to you and your lifestyle. By accepting the terms you agree not to share or sell to anyone else. The use of any information provided by Ash Mullen Fitness is solely at your own risk. Please note that if you opt to not share your transformation photos online (social media) you will not be eligible for the prizes. *There is a $99 cancelation fee if you need to end the challenge before the 12 weeks.

I have read and understand the disclaimer above

12-Week Build Challenge Registration

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