Name *
Home Address
Chronic illness/conditions
Email Address *
Phone Number *
Enter your phone number as: xxx-xxx-xxxx
Your preferred way to be contacted *
E mailP hone
Select which way we should contact you.
Weight *
Age *
How many hours are you currently training? *
How many hours have you trained since Jan 1st *
How many hours per week do you dedicate to training? *
List any group rides you are currently participating in. *
Please list any group rides you are currently participating in or rides you like to do.
List any weaknesses you see in yourself. *
Example: I die towards the end of long rides 3+/ or I cannot sprint well.
List any important dates such as traveling, immediate appointments that may conflict with training. *
List any goals or important events you would like to prepare for. *
Personality type *
f reakl oose spirit
Personality type: are you an organized “freak” or a loose spirit?
Estimate how many hours per week spent working, family, etc. *
Estimate how many hours per week you spend working, and with family or other structured activities such as school, clubs, and hobbies?
Resources *
Please list any available training resources, examples may be heart rate monitor, indoor trainer rollers, gym equipment, free weights, gym membership, Swiss ball, foam roller, etc.
Coaching Services 
