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* 1. Title

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* 2. Name

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* 3. Age

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* 4. Address

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* 5. Telephone number

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* 6. Email address

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* 7. Occupation

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* 8. Height

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* 9. Weight

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* 10. Target weight (enter the weight you would like to be)

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* 11. Do you have any injuries or health problems?

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* 12. Are you able to take part in weight bearing exercise?

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* 13. Do you have any special dietary requirements or allergies?

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* 14. Are you registering as an individual or a pair?

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* 15. If you are registering as a pair. What is your partner's relationship to you?

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* 16. Partner's name

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* 17. What is your main reason for applying for The Fit Factor?

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