Personal DetailsFull Name *Phone Number *Birthday *Address Line 1 *Address Line 2 *City *State *Postal Code *Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweStatus *StatusMarriedSingleSingle MotherDivorcedOccupation *Email Address *Instagram AccountFacebook NameHow did you know about us? *FriendsInstagramFacebookYouTubeGoogle SearchNewsRegistrationHeight (CM) *Current Weight (KG) *Fitness goal *I want to Reduce WeightI want to Improve StaminaI want to Be StrongerI want to Gain WeightI want to be General HealthyI want to be More Confident (Toning)I want to Have Fun and Feel ConnectedMaximum TWO onlyPreferred Session *TAMAN MELAWATI 12 Sessions, Morning (7:30am-8:30am) - Monday, Wednesday, FridayTAMAN MELAWATI 8 Sessions, Morning (7:30am-8:30am) - Monday, Wednesday, FridayTAMAN MELAWATI 8 Sessions, Night (8:15pm-9:15pm) - Monday, Thursday.EXTERNAL VENUE21 DAYS BACK ON TRACKEmergency Contact Person Name *Relationship *Emergency Person RelationshipHusbandFatherMotherSisterBrotherFriendsEmergency Contact Number *Medical QuestionaireAre you currently exercise *YesNoAny major illness or disabilities? *Are there any conditions that may limit your physical activity? *Do you suffer from any of the following? *Heart diseaseAsthmaHeart ConditionDiabetesBack PainEpilepsySpinal InjuriesHerniaArthritisHeart PalpitationsJoint PainsHi/Low Blood PressureTightness in ChestRheumatic FeverLiver/Kidney ConditionRegular HeadacheInfectionsMuscular Pain/CrampsChronic CoughHigh CholestrolBladder WeaknessAllergies to GrassAllergies to SandCurrently pregnantNO, I am healthytick ALL relevant boxesAre you on any special medication? *YesNoIf 'Yes' please state the medicationDeclaration *Yes, details above reflect my current medical & health conditionIC Number *without "-"Signature Name *Consent *Yes, I agree with the  Terms and Condition and Attendance Agreement. Payment Details Online Banking / Direct Bank-inDirect-Bank-in or online transfer Training Fees to:MaybankAccount Name: Elka Elza Legacy Sdn. Bhd.Account Number: 564016686890Recipient email: elkaandelza@gmail.comRecipient reference: YOUR NAME + MONTH 2024 Please WhatsApp bank-in slip or payment screenshot for payment at : +6017-3165459 NOTE:* You will need to make payment before or on the last date given before the new intake began, otherwise, it will be count as late payment.SubmitPlease do not fill in this field.
