Thanks so much for your interest in signing up for one of our Programs. Please take the time (only a couple minutes) to fill in the information in the boxes below and we will get back to you right away. The more info you give us before we connect with you, the more efficient we can be when we speak with you to develop your personal training plan.

Thanks, I am really looking forward to meeting you!

Contact Info

First Name Phone Address City Emergency Contact Name

Last Name Email Zip Country Emergency Phone

Background Info

Today's Date

Male or Female

Age

Date of Birth

Occupation Marital Status

Work Hours per typical week Kids? Ages?

Other Sports in your Past Other Sports you do Now

Training + Racing Info

Have you ever had a cycling coach?

Why did you not stay with them?

What are you looking for in a coach? What do you want from yourself?

List three of your strengths

List two of your weaknesses

Years Riding

Years Racing

Greatest Sporting Accomplishment

Most miles in one ride?

Most miles in one week (7 day period)?

List your top three priority events/races for 2010

Other events targeting this year (please include dates)

Do you use a Power Meter?

Heart Rate Monitor?

Stationary Trainer?

Are you happy with your Bike Fit? Are you happy with your Diet?

Hours/week you train

Do you typically do intervals? (please list what type)

Map out your typical training week (do the best you can with this):

Sunday Tuesday Thursday

Monday Wednesday Friday

Saturday

Health Info (almost done!)

Height

Weight

Weight goal (by when)

% Body fat

% Body fat goal (by when?)

List all past and present medical issues (especially Asthma, Heart, Knee):