7 Days - New Body, New Life

ALIVE Across America Registration

  • ALIVE ACROSS AMERICA

    THE NEXT PROGRAM BEGINS FOR YOU . . . NOW!

    By completing this form you are registering to participate in the nationwide ALIVE ACROSS AMERICA program, a 13-week interactive empowerment experience sharing the inside secrets of improving health, fitness, appearance, and well-being. The program has sold for $2425 but in this special offering, only for select clients of ALIVE Coaches or participants in the 21 Day Metabolic Reboot, you're registering to attend weekly webinars online for a significantly reduced amount. You will also receive the program handbook distributed in downloadable weekly segments delivered via email by downloadable pdf files. After a $15 enrollment deposit, you'll be billed only $25 per week for the 13 weeks of the program. After you register, you’ll receive details about “rolling into the existing program,” inviting you to participate with the present group moving through the program together. The first webinars take place at 7 PM Eastern Time on Monday evenings. Please complete as much of the below information as is applicable: (Note: registrations will be billed as outlined beginning the day of registration)
  • First Name *
    If you are an ALIVE coach registering a client, put the client's name here. You'll add your name in the field marked "Coach"
  • Last Name *
  • email *
  • Primary Interests, Goals, and Desired Outcomes
    just a few sentences about what you'd like the program to do for you
  • Billing Address
  • City
  • State *
  • Zip
  • Telephone Number *
  • Credit Card (for $15 deposit and weekly billing for 13 weeks - $25 per week) *
    Visa
    MasterCard
    AMEX
    Discover
  • Credit Card Account Number
  • Exp Date
    mm/yy
  • CVV
  • Coach
    If you were referred here by a Personal Trainer (certified A.L.I.V.E. Coach) please put the trainer's name and any pertinent info related to your present relationship with that coach. If you were not referred by an A.L.I.V.E. coach simply skip this section and scroll down
  • A.L.I.V.E. Coach
  • Relationship
    I am a regular client of the trainer / coach
    I am a new client of the trainer/coach and will be working out with him/her prior to beginning the ALIVE program in January
    I was referred to the trainer/coach and have not yet done or committed to a session
    I know the trainer/coach personally and have never actually been a client
    please choose the one that best applies. If necessary you can clarity in the field below
  • Additional Info Related to Trainer / Coach
  • Date of Birth *
    Month, Day, and Year (i.e. May 18, 1958)
  • When did you last have a physical examination by a medical professional? *
  • Comments / History . Physical or Medical Limitation
    If you do not have any diagnosed chronic conditions, health challenges, or medical concerns, you can scroll down and hit SUBMIT
  • Please check any that you have personally been diagnosed with at any time
    Hypertension (High Blood Pressure)
    Hypothyroidism or Thyroid Disease
    Blood Sugar Irregularity (hyperglycemia, pre-diabetes, type 2 diabetes, etc.)
    hypercholesterolemia (high cholesterol)
    Chronic Fatigue Syndrome or Fibromyalgia
    Arthritis
  • Provide details on any conditions checked or describe any that were not mentioned above
  • Medications
    List any medications that you are presently taking or that you take on a continual basis (if you know the classification or reason for taking each please include it, i.e. crestor for cholesterol)
  • Brief Summation of Your Exercise Experience and History
  • Additional Comments
  • Check for Follow-Up
    I realize an A.L.I.V.E. coach is optional but please have somebody contact me, without any additional charge, to discuss whether or not I'd benefit from additional support or to explain specifics of the program
  • Emergency Contact *
    Please provide name and telephone number of the person you'd like contacted in the event of any emergeency
  • Check any that would apply
    I already have a membership to an ALIVE licensed Fitness Center or a facility in which a qualified ALIVE Coach conducts training sessions
    I live or work near a Memorial Hospital Fitness Center and would like a comp membership over the term of the program
    I live or work near a Merritt Athletic Club and would like a comp membership over the term of the program
    I live or work near Bodez and would like a comp membership over the term of the program
    I intend to work out at home
    I intend to workout in a gym or fitness center not presently affiliated with the ALIVE program