Online Fit-Life Coaching registration form
Please fill in the form below to register for your Online Fit-Life Coaching.
*mandatory fields.
個人資料
名字
*
此欄位必須填寫
姓氏
*
此欄位必須填寫
您是否PURE持卡人
*
是
否
此欄位必須填寫
會員號碼
*
此欄位必須填寫
手機號碼
*
此欄位必須填寫
電郵地址
*
此欄位必須填寫
Date of Birth
*
此欄位必須填寫
Current weight (kg)
*
此欄位必須填寫
Height (cm)
*
此欄位必須填寫
Location and time zone
*
(GMT-12:00) International Date Line West
(GMT-11:00) Midway Island, Samoa
(GMT-10:00) Hawaii
(GMT-09:00) Alaska
(GMT-08:00) Pacific Time (US & Canada)
(GMT-08:00) Tijuana, Baja California
(GMT-07:00) Arizona
(GMT-07:00) Chihuahua, La Paz, Mazatlan
(GMT-07:00) Mountain Time (US & Canada)
(GMT-06:00) Central America
(GMT-06:00) Central Time (US & Canada)
(GMT-06:00) Guadalajara, Mexico City, Monterrey
(GMT-06:00) Saskatchewan
(GMT-05:00) Bogota, Lima, Quito, Rio Branco
(GMT-05:00) Eastern Time (US & Canada)
(GMT-05:00) Indiana (East)
(GMT-04:00) Atlantic Time (Canada)
(GMT-04:00) Caracas, La Paz
(GMT-04:00) Manaus
(GMT-04:00) Santiago
(GMT-03:30) Newfoundland
(GMT-03:00) Brasilia
(GMT-03:00) Buenos Aires, Georgetown
(GMT-03:00) Greenland
(GMT-03:00) Montevideo
(GMT-02:00) Mid-Atlantic
(GMT-01:00) Cape Verde Is.
(GMT-01:00) Azores
(GMT+00:00) Casablanca, Monrovia, Reykjavik
(GMT+00:00) Greenwich Mean Time : Dublin, Edinburgh, Lisbon, London
(GMT+01:00) Amsterdam, Berlin, Bern, Rome, Stockholm, Vienna
(GMT+01:00) Belgrade, Bratislava, Budapest, Ljubljana, Prague
(GMT+01:00) Brussels, Copenhagen, Madrid, Paris
(GMT+01:00) Sarajevo, Skopje, Warsaw, Zagreb
(GMT+01:00) West Central Africa
(GMT+02:00) Amman
(GMT+02:00) Athens, Bucharest, Istanbul
(GMT+02:00) Beirut
(GMT+02:00) Cairo
(GMT+02:00) Harare, Pretoria
(GMT+02:00) Helsinki, Kyiv, Riga, Sofia, Tallinn, Vilnius
(GMT+02:00) Jerusalem
(GMT+02:00) Minsk
(GMT+02:00) Windhoek
(GMT+03:00) Kuwait, Riyadh, Baghdad
(GMT+03:00) Moscow, St. Petersburg, Volgograd
(GMT+03:00) Nairobi
(GMT+03:00) Tbilisi
(GMT+03:30) Tehran
(GMT+04:00) Abu Dhabi, Muscat
(GMT+04:00) Baku
(GMT+04:00) Yerevan
(GMT+04:30) Kabul
(GMT+05:00) Yekaterinburg
(GMT+05:00) Islamabad, Karachi, Tashkent
(GMT+05:30) Sri Jayawardenapura
(GMT+05:30) Chennai, Kolkata, Mumbai, New Delhi
(GMT+05:45) Kathmandu
(GMT+06:00) Almaty, Novosibirsk
(GMT+06:00) Astana, Dhaka
(GMT+06:30) Yangon (Rangoon)
(GMT+07:00) Bangkok, Hanoi, Jakarta
(GMT+07:00) Krasnoyarsk
(GMT+08:00) Beijing, Chongqing, Hong Kong, Urumqi
(GMT+08:00) Kuala Lumpur, Singapore
(GMT+08:00) Irkutsk, Ulaan Bataar
(GMT+08:00) Perth
(GMT+08:00) Taipei
(GMT+09:00) Osaka, Sapporo, Tokyo
(GMT+09:00) Seoul
(GMT+09:00) Yakutsk
(GMT+09:30) Adelaide
(GMT+09:30) Darwin
(GMT+10:00) Brisbane
(GMT+10:00) Canberra, Melbourne, Sydney
(GMT+10:00) Hobart
(GMT+10:00) Guam, Port Moresby
(GMT+10:00) Vladivostok
(GMT+11:00) Magadan, Solomon Is., New Caledonia
(GMT+12:00) Auckland, Wellington
(GMT+12:00) Fiji, Kamchatka, Marshall Is.
(GMT+13:00) Nuku'alofa
Occupation and shift pattern (if any)
*
此欄位必須填寫
Preferred time to hold for consultation
*
Morning
Afternoon
Evening
此欄位必須填寫
Experience of Personal Training/Nutrition Coaching
Is this the first time you have had a personal trainer?
*
Yes
No
此欄位必須填寫
If no How long were you with a personal trainer for?
*
Less than 6 months
6 months to 1 year
1 to 3 years
3 to 5 years
More than 5 years
此欄位必須填寫
Are you currently a member of another fitness centre?
*
Yes
No
此欄位必須填寫
Do you have any medical or physical conditions that may prevent you from engaging in physical exercise?
*
Yes
No
此欄位必須填寫
Do you currently have any injuries?
*
Yes
No
此欄位必須填寫
If you are female, are you currently pregnant?
*
Yes
No
此欄位必須填寫
If yes How many weeks are you into your pregnancy?
*
此欄位必須填寫
Are you currently exercising regularly?
*
Yes
No
此欄位必須填寫
If yes How often?
*
此欄位必須填寫
What are your goals? Rank in order of importance [1=the most important]
*
Fat loss
1
2
3
4
5
Muscle retention
1
2
3
4
5
Improved energy
1
2
3
4
5
General health
1
2
3
4
5
Education
1
2
3
4
5
此欄位必須填寫
Which gender would you prefer for your PURE Personal Trainer?
*
Male
Female
No preference
此欄位必須填寫
Which gender would you prefer your nutritionist/dietitian to be?
*
Male
Female
No preference
此欄位必須填寫
Please pick preferred language of coaching (Note all support material is in english)
*
Cantonese
English
Mandarin
No preference
此欄位必須填寫
Any other important information you would like to provide for your Online Fit-Life Coaching?
*
此欄位必須填寫
Fit-Life Coaching Promotion – Terms & Conditions
• This promotion is available to both PURE Cardholders and non-PURE Cardholders in Hong Kong only.
• Online sessions may be transferred to in-person sessions at the PURE location where the Nutritionist or Personal Trainer is based after PURE Fitness locations re-open.
• This promotion is only valid while PURE Fitness locations in Hong Kong are closed and will end at 23:59:59 the day before PURE Fitness is scheduled to re-open.
• Guests must purchase the 12-week Fit-Life Coaching package to be eligible for the free set of resistance bands (including 3 bands).
• Each person may only redeem one set of resistance bands during the promotion period.
• All purchases must be paid in full online before the resistance bands are delivered.
• PURE reserves the right of choice in the PURE Nutritionist and Personal Trainer provided
• This promotion cannot be used in conjunction with any other promotional offer or discount.
• Any dispute connected in any way with this promotion will be resolved by PURE at its absolute discretion.
提交