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Complete this form to join Ripped 4 d Road 2020.
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
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Isle of Man
US Virgin Islands
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Western Sahara
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Phone Number
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Area Code
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E-mail
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We promise not to spam you.
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7
Are you new to F.A.M?
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8
What type of training are you signing up for?
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If corporate, Select Corporate, click next & Submit. A F.A.M team member will contact you within 48hrs
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9
What's your fitness goals?
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Weight Loss
Weight Gain
Tone up
Stay Healthy
Other
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10
Which location would you like to train?
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Aranguez - Savannah (Mon-Thurs 6pm-7pm)
Arima - Veladrome (Mon-Thurs 7pm-8pm)
Chaguanas - Lange Park (Mon - Thurs 5.30pm-6.30pm)
Macoya - Constantine Park (Mon-Thurs 7pm-8pm)
Port of Spain - QPS (Mon-Thurs 5am-6am)
Port of Spain - QPS (Mon-Thurs 6am-7am)
Port of Spain - QPS (Mon-Thurs 4.30pm-5.30pm)
Port of Spain - QPS (Mon-Thurs 5.30pm-6.30pm)
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11
Do you have an existing injuries or health concerns?
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12
In case of emergency who can we contact?
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First Name
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13
What's their contact number?
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Area Code
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14
Membership
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All prices include a F.A.M Package and Health Insurance under Fit Addicts Movement
New F.A.M Member ($1400)
Returning F.A.M Memeber ($1350)
No F.A.M Package ($1200)
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Special Offer!!
3 members pay in full > 4th member gets half off. || 4 members pay in full > 5th member free. || List other members below along with contact number, and have them complete this form.
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16
How will you be paying?
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Make deposit at FCB Acct# 243-2139 (Daniel Philip)
Cash
Linx
Bank Transfer
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17
What's your payment option?
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For Full Payment option, payments should be made prior to the beginning of 1st month. For two payments, first payment $900 is due at the beginning of 1st month, and balance the following month. NOTE: For part payment option, payments must be paid off in full as promised as we would have committed to providing you with an easy payment plan
Full Payment
Two Payments ($900 then balance)
Three Payments ($400 monthly)
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18
Note
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Clients who have sustained injuries, undergone surgical procedures or suffer from serious medical conditions are required to OBTAIN MEDICAL CLEARANCE BEFORE SIGNING UP for our programme. F.A.M (Fit Addicts Movement) strongly recommends you consult your doctor before any fitness activities. Disclaimer The Management and staff of F.A.M (Fit Addicts Movement) will not liable or accountable for any injuries or medical conditions sustained while training or during membership enrollment.There is a non-refund policy.
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19
Promissory Note
This agreement states that I agree and promise to pay to Fit Addicts Movement (Daniel 'Pablo' Philip) the balance in the sum of ($900 followed by balance) for Fitness Services rendered, payable by Jan 2, 2020 and Feb 29, 2020 respectively. If payment not made by stated date, please contact Pablo to discuss payment option. If 0% of balance is paid after discussion with Pablo, this note will be in default and placed for collection by a collection agency, I shall pay all reasonable costs of collection including attorneys' fees.
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20
Feedback about us:
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21
Suggestions if any for further improvement:
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22
Image Field
See you in 2020
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