Personal Trainers Lead Application

Personal Trainers Application

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

State/Prov*
State/Prov*

City*
City*

Zip/Postal Code*
Zip/Postal Code*

E-mail Address*
E-mail Address*

Business Phone*
Business Phone*

Web Site URL*
Web Site URL*

Your Business Name or Corporation*
Your Business Name or Corporation*

Current Employment*
Current Employment*

	Owner of Fitness Company
	Self Employeed - Sub Contract Work
	Employee Fitness Center
	Employee Fitness Studio

Service Area Coverage - Please List All Cities & Town Names in Detail as well as Zip Codes*
Service Area Coverage - Please List All Cities & Town Names in Detail as well as Zip Codes*

Where do you train your clients?*
Where do you train your clients?*

	In-Home - Client Supplied Equip.
	In-Home - Trainer Supplied Equip.
	Fitness Studio
	Fitness Center - Membership Req.

Fitness Experience and Goals - How Long in the Industry and Your Philosophies on Personal Training*
Fitness Experience and Goals - How Long in the Industry and Your Philosophies on Personal Training*

Educational Background - Include Fitness, Exercise, and Health Related Studies*
Educational Background - Include Fitness, Exercise, and Health Related Studies*

Fitness Training Certifications*
Fitness Training Certifications*

Any Specialized Training - Boot Camp, Plyometrics, Kettle Ball Training, Etc.*
Any Specialized Training - Boot Camp, Plyometrics, Kettle Ball Training, Etc.*

If approved, as a My Personal Trainer Fitness Network Service Provider, I agree to pay My Personal Trainer ( Body Perfect Fitness, Inc.) a percentage of total revenues generated from a client membership and/or any personal training fitness package that is generated from a fitness lead through the My Personal Trainer Fitness Lead System.*
If approved, as a My Personal Trainer Fitness Network Service Provider, I agree to pay My Personal Trainer ( Body Perfect Fitness, Inc.) a percentage of total revenues generated from a client membership and/or any personal training fitness package that is generated from a fitness lead through the My Personal Trainer Fitness Lead System.*

I AGREE TO ALL STATEMENTS ABOVE

Please enter the word that you see below.