Ladies Flyer Applications - Rossell Fitness

Fill This Form in if You are A Lady In Leicester Who Wants to Change

Please be honest and give as much detail as you can, I will review the form as soon as I can and you will receive notification of when you can book in for a phone interview.

Name*
First Last
Email*
Phone*
Current weight*
Current clothing size*
Target weight (kg)*
Target clothing size*
How many times have you attempted to lose weight before this?*
- Never
- 1-2
- 3-4
- 5-6
- 7+
- I can't remember a time when I wasn't dieting or trying to lose weight
What makes this time different? Why are you doing this now?*
The deeper you can go into this question the better! For example: 'I am doing this now because I can no longer play with my kids without getting out of breath, I can't climb the stairs without sweating and I feel unhealthy. It is different this time because I have never felt so unhappy and I am determined to change for good this time'
Please select which best describes you (for the majority of the time)*
- Meat eater
- Vegetarian
- Vegan
Please describe what has to happen in your life in the next 12 months for you to be healthy and happy*
Again, go deep here, really think about it! Imagine we are having this conversation in a years time, what does it feel like, what do you look like, what has changed?
Please describe why you think you are a good fit for this weight loss opportunity...*
This course is NOT for everyone, this is your application to be considered for a place - do your best to show me that you are READY and WILLING to change and get some amazing results!
Check the box to confirm that the information you have provided is correct and accurate to the best of your knowledge and to give your consent to be contacted by Rossell Fitness*
- I confirm
Thanks for filling in my form and I will be in touch very soon! I recognise that I am freely giving my contact details to Rossell Fitness, and that my details WILL be used to contact me regarding my request and other related promotions. I give my full consent for this.Your data will be protected and never shared with third-party companies. In accordance with GDPR regulations, you are entitled to request to see what information is held about you, opt out of any communication at any time and change any information we hold. We will comply with your request within the designated time frame.