Mobile Fit and Wellness :: Pre-Register for Your Event with Mobile Fit & Wellness

			"Body Fat Percentage will become a new standard for health in adults" C. Everett Koop, Former Surgeon General Check the EVENT CALENDAR for upcoming test dates and locations

Mobile Fit & Wellness Event Pre-Registration Form

You can pre-register for your fitness testing event. Check the event calendar for the correct location and date of your event. Fill out the form below and submit the form. Please contact your on-site event coordinator to schedule a time for your testing. We look forward to seeing you. Thank you.

Your Event Location and Date
1. First and Last Name
2. Address
3. City
4. State and Zip Code
5. Phone Number
6. Email
7. Age
8. Height
9. Current Weight
10. Are you a member of this facility whose premises we are testing on? Yes No 11. If not, how did you hear about this testing? poster/sign website internet search referral (if so, who)
12. Is this your first time testing with Mobile Fit and Wellness? Yes No
13. How Would you Describe Your Work Activity:	active moderately active sedentary
14. Rank your fitness goals in order of importance to you:
Lose Fat Gain Muscle	Tone Up Maintain Current Weight	Stress Management Medical Advice
15. How many times per week do you work out?	1 2 3 4 5 6
16. How many times per day do you eat?	1 2 3 4 5 6
17.Have you ever kept track of your calorie intake?	Yes No If yes, daily weekly monthly never
18. Have you ever worked with a trainer?	Yes No If yes, trainer's name:
Release of Liability, Assumption of Risk, Hold Harmless, Agreement to Indemnify I am voluntarily participating in the testing offered by Mobile Fit & Wellness, and am of legal age and voluntarily sign this release of liability, assumption of risk, hold harmless, agreement to indemnify and not to sue. I am also aware that Mobile Fit & Wellness works in conjunction with the facility on whose premises we are located. I understand that Mobile Fit & Wellness shares information regarding who is participating in the testing, but does not share test results. By submitting this form, you agree to all terms and conditions stated above.

Do you have a question or need help? Call us or use the Contact Form.

Denise Caton
800 817-7357 tel
888 627-7617 fax


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Check the EVENT CALENDAR for upcoming test dates and locations

Do you have a question or need help? Call us or use the Contact Form.