Please take a few minutes, fill in this form, and start your fitness journey with Wicked Strong Fitness Bootcamps.
Billing Option:
*
Monthly Recurring ($180.00)
Monthly Billing
*
When you sign up for this option you will be automatically billed to your credit card the same time every month until you cancel.
Price:
$180.00
Preferred timeslot
*
We request that you indicate your preferred time to come to Bootcamp. If, for some reason, your schedule prevents you from making it one week for "your" time slot, requests to come during another time slot will be entertained.
7:15am
Monday / Wednesday / Friday
8:30am
Monday / Wednesday / Friday
4:15pm
Tuesday / Thursday / Friday (or
8:00am
Saturday)
6:00pm
Tuesday / Thursday and
9:00am
Saturday
Full Name
*
Your name (as seen on the Credit Card you will use to pay with)
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
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
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone
*
Remember, we will
never
sell, misuse or abuse your contact information. We only ask for your phone number to ensure we're able to reach you in the event of weather cancellations or other emergencies.
Email
*
Remember, we will
never
sell, misuse or abuse your contact information. We only ask for your e-mail address to sign you up to our Bootcamp distribution list where we post schedule updates, bootcamp changes or weather cancellations and other emergencies.
Enter Email
Confirm Email
Emergency Contact
*
Please enter the name of the person we should contact in the event of a medical emergency.
First
Last
Emergency Contact Phone
*
Please enter the phone number where the individual listed as your emergency contact may be reached
Form validation
Please enter the two words listed. This is used to attempt to minimize the number of computer based data "harvesting" tools.
Date
Wicked Strong Bootcamps
66 Hannover Street, Suite 101
Manchester
,
NH
,
03101
USA
christine@wickedstrongchicks.com
• 
603-384-3376
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