TEXINS CHALLENGE - 6 Week Fitness Performance Program 2019

Question Title

* 1. First Name:

Question Title

* 2. Last Name:

Question Title

* 3. Email Address

Question Title

* 4. Are you currently a TI employee?

Question Title

* 5. Are you a Texins Member?

Question Title

* 6. Program Cost: $60 Texins Member; $170 Non- Member. Please select your payment option.

$60 Texins Member, Payroll deduction (TI employees only).By selecting this option you are authorizing Texins to proceed with the $60 payroll deduction charge.

$60 Texins Member, Credit Card. Please provide credit payment at the front desk at Texins Fitness Center by Tuesday July 9th

$170 Non Texins Member, Payroll deduction (TI employees only). By selecting this option you are authorizing Texins to proceed with the $170 payroll deduction charge.

$170 Non Texins Member, Credit Card. Please provide credit payment at the front desk at Texins Fitness Center by Tuesday July 9th

Question Title

* 7. Commitment is Key! The results you can expect from this program will reflect your commitment to the program.

I will ensure that I will carry out the full program by attending both classes for the full six weeks. (Please sign below)

Thank you for participating in the 2019 Texins Challenge!

Question Title

* 1. First Name:

Question Title

* 2. Last Name:

Question Title

* 3. Email Address

Question Title

* 4. Are you currently a TI employee?

Question Title

* 5. Are you a Texins Member?

Question Title

* 6. Program Cost: $60 Texins Member; $170 Non- Member. Please select your payment option.

Question Title

* 7. Commitment is Key! The results you can expect from this program will reflect your commitment to the program. I will ensure that I will carry out the full program by attending both classes for the full six weeks. (Please sign below)

* 7. Commitment is Key! The results you can expect from this program will reflect your commitment to the program.

I will ensure that I will carry out the full program by attending both classes for the full six weeks. (Please sign below)