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CORPORATE INTAKE
Today's Date
*
September 2026
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Last Name
*
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First Name
*
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Company Name
*
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Company Mailing Adress
*
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Email Address
*
Please enter a valid email address.
Cell Phone Number
*
Please enter a phone number.
Company Phone Number
*
Please enter a phone number.
What is your role at the company?
*
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What are the comapany's goals?
*
required
Building a strong team culture
Increasing energy at work
Attracting and retaining staff
Decreasing healthcare costs
Staying connected away from the office
Getting employees moving
How big is your comapny? (# of employees)
*
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Where are you located?
*
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Do you have a wellness program already?
*
required
Yes
No
Training Availability (Times of the day)
*
required
Morning
Afternoon
Evening
Training Availability (Days of the week)
*
required
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Training Program Commitment (Months)
*
required
1-3 Months
4-6 Months
7-12 Months
Training Program Commitment (sesions per week)
*
required
1
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6
Training Program Start Date
*
September 2026
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31
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Payment Options
*
required
Weekly
Bi-weekly
Monthly
Pay in full
Other (payments > Monthly; < Pay in full)
Additional Comments
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