Print out this page and complete it as accurately as possible. Please type or print clearly.
Personal Info
First and Last Name:
________________________________________________________
Home Address:
City: _____________________ State: _____ Zip: _______ Country:___________
Daytime Phone #: (_____)____________ Evening Phone #: (____)___________
E-mail Address: _________________ Alternate E-mail Address: ________________
Briefly describe your 12 week fitness goals. What would you like to accomplish? ____________________________________________________________________
____________________________________________________________________
Date Before Materials were completed*: ___________
*Note: "Before Materials" = Before Entry Form, Before Health Status Report, and Before Photos. These must be mailed within 5 days of completion but must be postmarked no later than October 1st, 2009.
I hereby verify that all information and statements made in this application are true. I understand that if my application is incomplete, it will not be considered for judging. I also understand that my completed Before Materials must be postmarked no later than October 1st, 2009, to be considered for judging.
I agree that by submitting my application, I am transferring ownership of my photographs and essay to GHF to be used in accordance with the contest rules and regulations. I also agree that my name, photographs, and essay may be used to promote GHF's online membership program and future contests, without limitation, as provided in the contest rules and regulations. I am 18 years of age or older and competent to understand and abide by this agreement.
I have read and understood the rules and regulations of the GHF Fitness Challenge in their entirety. By signing below, I agree to abide by all rules, regulations, and requirements for competition in this contest.
Your Signature:__________________________________
Printed Name: ___________________________________
You must complete 2 of the 3 tests below. Click here for details on the special requirements for each test.
1. Body Composition
Age: ______ Weight:________
Skinfold measurements in millimeters (mm):
Click here for instructions and illustrations of skinfold measurement sites and the chart to use in determining your Body Fat Percentage, Fat Weight, and Lean Body Weight.
Body Fat % = ________
Fat Weight (Body Fat % x Scale Weight) = ________
Lean Body Weight (Scale Weight - Fat Weight) = ________
Name of person administering Body Composition Test*: ____________________
Credentials/Certifying Organization and # (e.g., ACE T29124): _______________
__________________________________________________
Signature of test administrator: ________________________________
Date test was administered**: ________
*Must be the same person as documented in your After Health Improvement Report (12 weeks from now).
**Must be within 5 days of the Before Materials postmark date.
2. Cholesterol Screening
LDL Cholesterol: ______ HDL Cholesterol: ______ Total Cholesterol: ______
Name of person administering Cholesterol Screening: ____________________
Credentials/Position: ______________________________________________
Signature of screening administrator: ________________________________
Date screening was administered**: _________
Click here for more information on Cholesterol Screening requirements.
3. Strength Test
Upper Body Strength Test (Choose A or B and fill in weight used):
A. Bench Press (Bb) One Rep Maximum_____lbs. 10 Rep Maximum ____lbs.
B. Bench Press (Db) One Rep Maximum_____lbs. 10 Rep Maximum ____lbs.
Lower Body Strength Test (Choose A or B and fill in weight used):
A. Squats (Bb) One Rep Maximum_____lbs. 10 Rep Maximum ____lbs.
B. Leg Press One Rep Maximum_____lbs. 10 Rep Maximum____ lbs.
Note: Bb = using a barbell Db = using a dumbbell 1 kg. = 2.2 lbs.
Name of person who spotted you while lifting*: ____________________
Your relationship with the spotter (check one)
a. Personal trainer:____ b. Gym staff:___ c. Workout partner:___ D. Other:_____
Signature of spotter (Spotter, please only sign if applicant used good, slow lifting technique): ________________________________
Click here for more info on Strength Testing requirements.
Please check one of the following:
I have enclosed 2 Before Photos with this application (prints or on disk).
I have attached 2 digital Before Photos to an e-mail message (send to info@global-fitness.com)
Date photos were taken**: ________
Click here for complete details on photo requirements.
Print out, complete, and include the following checklist when you send in your Before Materials:
I have completed and included the entire Before Entry Form, with name, address, city, state, zip code, e-mail, daytime and evening phone numbers, and the Before Materials completion date.
I have affixed my signature, affirming that I have read and understood the Rules and Regulations of this contest and will abide by them.
I have included two (2) Before Photos with appropriate date verification information as required. Click here for photo requirements.
I have completed my Before Health Status Report, with documented evidence in at least 2 of the 3 categories (Body Composition, Cholesterol or Strength). A qualified witness has signed each test in the appropriate place. I understand that the same witness must document my After Health Improvement Report in 12 weeks.
Be sure to mail completed Before Materials* (photos may be sent by e-mail) postmarked NO LATER THAN midnight, October 1st, 2009, to Global Health & Fitness, 12550 SE 93rd Ave., Suite 210, Clackamas, OR 97015.
*Note: "Before Materials" = Before Entry Form, Before Health Status Report, and Before Photos.
Questions? Email us at info@global-fitness.com. You'll get a prompt, detailed response within 24 hours.
