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Health Challenge Enrollment

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Name *

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Last

Email *

Phone Number *

Are you ready to make a change? *

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What are your biggest challenges when it comes to nutrition and fitness? *

Are you willing to commit to 21 days with me to improve your health & fitness? *

Yes No

What are your current health and fitness goals? Describe your current nutrition/fitness routine. *

Are you willing to commit to 21 days with me to improve your health & fitness? *

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