Pack Application

Name: *

E-mail *

Any Fun Facts: *

What is the image you have of you at your best? Please describe. *

What are your goals for the next 6 months? *

Why is that goal important to you? *

How many days can you commit to exercise? *

Less then 3

More then 3

What are you willing to give up? (Facebook, happy hours, daily donut habit. :) ) *

What has gotten in your way in the past? *

How will you reward yourself? *

Last one: How do you like to be supported. *