General Details

First Name
 
Surname
 
Email
 
 
Birthday
 (dd/mm/yyyy)  
Mobile Number
   
 
Other Contact
 
 
Street Address
 
Suburb
 
State
 
Country
Postcode
 
  I allow DIYPT to use images of me for marketing purposes
Password
Confirm password
 

Program Specific Details

1. What is your training goal?
2. Where would you prefer to exercise for your DIYPT program?
3. Do you have any dietary requirements?
4. Do you have any medical conditions that will prevent/disrupt you from training?
5. Are you currently on any medication ?
6. How did you hear about us?

  Membership Agreement

 
I have read and understood the Terms and Agreement of this membership. I acknowledge that the information given on this form is true and correct and I understand that DIYPT will not pass these details to any third party without my authorization.
I understand that my membership will run for a minimum of 13 weeks.