Dear Frank,
Enclosed is $_____in full payment for my private
Zane Experience on the dates of
______________________________________________.
NAME________________________________AGE_____SEX_____
STREET_________________________________________________
CITY________________________STATE_______ZIP____________
PHONE____________E-MAIL___________HEIGHT_____WT____
JOB___________________PRIOR WT.
TRAINING_______YEARS
MY GOALS
ARE__________________________________________
_________________________________________________________
_________________________________________________________
I WANT TO PARTICIPATE IN ZANE EXPERIENCE BECAUSE
_________________________________________________________
_________________________________________________________
DO YOU HAVE ANY INJURIES OR DISABILITIES?
___________ IF SO, ATTACH NOTE FROM A MEDICAL DOCTOR PERMITTING YOU TO
DO OUR PROGRAM.
I HOLD FRANK ZANE FREE FROM ALL LIABILITY AND
FULLY UNDERSTAND THAT I PARTICIPATE IN THE ACTIVITIES AT ZANE
EXPERIENCE AT MY OWN RISK AND THAT NO REFUND IS GIVEN.
SIGNED_______________________________DATE____________
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