JMax Fitness

First name*

Last name*

Email*

Confirm email*

Skype ID or Phone Number:*

What motivates me the most to work with JMax Fitness at this time in my life is...*

My #1 challenge in health and fitness right now is...*

If I were to have this discussion with Jason in a year from today, and I was looking back on the past 12 months, this is what would have to happen in my life both personally and in fitness for me to feel happy with my progress...*

I know that working with JMax Fitness is by APPLICATION ONLY, and there is always a waiting list, but this is why I think I'd be a great fit to work with JMax Fitness...*

Fill in the blank: I am...*

An "Excuse Maker" who looks for opportunity but then finds 'reasons' not to take advantage of them.

A "Procrastinator" who wants to take action but never pulls the trigger until the opportunity is gone.

An "Action Taker" who sees and opportunity and moves forward quickly.

My current annual income (salary) is:*

Under $50,000 USD per year.

$50,000-$74,999 USD per year.

$75,000-$99,999 USD per year.

Over $100,000 per year.

Prefer not to disclose.