21 Day Detox Application This program is by application only. We have room for 20 more committed and qualified busy boomers, so if you'd like to get more information and find out if you're a good fit, then you must first fill out this application completely. The first 20 people who submit their complete application and qualify will be the only ones to make it in. All applications will be reviewed in the order that they're received. By joining this program, you can expect increased energy levels, learn to eat in a supportive way for an active lifestyle, and achieve more physically than you ever have before! Unfortunately, not everyone will qualify to get in. We are not a big box gym, and we want to give each client the personal attention they need to reach their goals, so please fill out the application below completely and honestly. First Name*Last Name*Email* Phone*When is the best time to call you for a quick strategy session?*What are you looking to accomplish with our program?Over the past year, I have been....Rapidly gaining weightSlowly gaining weightStaying stagnantSlowly losing weightRapidly losing weightWhat has been your biggest struggle around trying to lose weight/get fit?Our program gets serious results but requires a serious investment. Are you willing to spend $49-$69 to get those results? Yes No Our clients are most successful in this program when they participate with friends. Please provide name and email for a friend who may be interested.