Registration Form - Fit Life Style

Step 1 of 3 – General Information

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First Name*
Last Name*
Email Id*
Mobile No*
Age*
Birth Date*
Gender*
- Male
- Female
- Other
Weight*
Height*
Address*

Street Address

City

State / Province / Region

ZIP / Postal Code

Country
What do you do?*
Company Name

Health Concerns
Are you taking any medication or drugs? If yes, list medication
Do you smoke?
Do you drink alcohol?
What time do you sleep?
What time do you wake-up?
What is your current fitness goal?
How many times do you exercise per week?
What type of exercise do you do?
Food Allergens / Food intolerance
How many liters of water you drink a day?

Choice of Food*

Please select eggeterian if you eat eggs, don’t put under vegetarian category.
Number of meals per day
Daily diet pattern ( mention foods and quantity)
Breakfast
Mid-morning
Lunch
Evening
Dinner
Pre-workout nutrition
Post-workout nutrition
Name

This field is for validation purposes and should be left unchanged.

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