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6 Week Challenge

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Fill out Form Below and you will be Contacted

Select which challenge you are inquiring about in the scroll down menu "Choose Challenge Program" box below. * Your information is kept STRICTLY confidential. *

PLEASE ANSWER BOX IN RED THAT SAY'S "HOW DID YOU HEAR ABOUT US"

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Cell Phone:
Best Time To Call Cell:	Morning Afternoon Evening Anytime
Home Phone:
Best Time To Call Home:	Morning Afternoon Evening Anytime
Work Phone:
Best Time To Call Work:	Morning Afternoon Evening Anytime
E Mail:
Why are you READY for results?:
Choose Challenge Program:	6 week workout class 6 week nutrition class 6 week phone calls
How Did You Hear About Us:	Ad on a Car Real Health & Image Newspaper Church Dr. Iezzi Family Medical Center Friend Inspire Magazine Letter in Mail Lifestyles Fitness Local Monthly Paper Local Newspaper - Tampa Bay Woman Previous Client NET WIB Nutrition Store Post Card Radio Spirit FM Radio WTBN AM Sign on Road Surfing Web Tampa Bay Metro Magazine Women N Charge Yellow Pages Other

*Additionally, if you have any questions, feel free to email them to us through the above form.

Or call

813-909-4939

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Samantha Taylor...Health & Nutrition Expert, Certified Personal Trainer, Life Coach & Professional Speaker