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911 Fitness Challenge 2009 REGISTRATION
(TEAM REGISTRATION Application - all team members must be listed on this one application, completed and signed by the Team Captain)

Applications will be sorted based on the Team Name.

Team Name
Weigh-In City
Region

YOU ARE RESPONSIBLE FOR SENDING (EMAIL: Jim@FitnessCommitmentInstitute.org) US YOUR TEAM PHOTO,

WITH YOUR TEAM NAME SIGN (8 X 10 WHITE PAPER WITH BLACK BOLD INK - VERY LARGE LETTERS)
PHOTOGRAPH ONE WEEK BEFORE BOTH (Jan & Apr) WEIGH-INS FOR BACK-UP PURPOSES

 
I, ,

as Team Captain and on behalf of my Team, hold harmless the 911 Fitness Challenge, as well as any and all companies associated with the 911 Fitness Challenge, of any injuries or physical illnesses if occurred while preparing and training during the course (12-weeks) of this competition. We understand and agree that the 911 Fitness Challenge has the final decision on declaring who the winners are of the 911 Fitness Challenge, without dispute. We consent and release the use of our photograph and body composition data to be used by the 911 Fitness Challenge, or any of the sponsors associated with the 911 Fitness Challenge for promotional purposes. Furthermore, we are responsible and liable for our own actions and daily exercise and nutrition, training regime.  
By typing your name in this field, you are hereby giving a digital signature.
Signature
Today’s Date: 

 

Team members information below.  Fill in 5 applicant's information.

Team Member Applicant Number 1

Shirt Size
1st Registrant's Name (Captain)
Phone
Address
City
Zip
Email:

Team Member Applicant Number 2
Shirt Size
2nd Registrant's Name
Phone
Address
City
Zip
Email:

Team Member Applicant Number 3
Shirt Size
3rd Registrant's Name
Phone
Address
City
Zip
Email:

Team Applicant Number 4

Shirt Size
4th Registrant's Name
Phone
Address
City
Zip
Email:

Team Member Applicant Number 5
Shirt Size
5th Registrant's Name
Phone
Address
City
Zip
Email:

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