Orlando Retreat

November 6th-8th

To help us give you the best personalized retreat possible, please fill out the form below.

Name

First Name

Last Name

Age

Months working out with Jeff/Twitch

Are you a member of the Mum-Fit Personal Training Crew?

Yes

If you have any chronic medical problems, describe them here.

What medications do you take?

List any prior surgeries.

List any joint injuries or problems.

Describe any current physical limitations.

List any vitamins or supplements you are currently taking.

List any dietary restrictions or food allergies.

Would you like to schedule a private session with Jeff during the weekend?

Yes

Unsure