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USANA Health Sciences

Nutritionals You Can Trust

  • Weight Management
  • Athletic Performance
  • Business Opportunity
www.harvellfitness.USANA.com

Training Programs and Rates

Program I – Get in Shape

Program II – Train for Competition

Other Information You Should Know

Client Application

Name:
Birth Date:
Age:
Address:
Home Phone:
Cell Phone:
E-mail:
Emergency Contact Person and Phone Number:

Check the program you want:
Program I
Program II
Do you know, or have you had in the past:
History of heart problems, chest pain, or smoke
Increased blood pressure
Any chronic illness or conditions
Difficulty with physical exercise
Advise from physician not to exercise
Recent surgery (past 12 months)
Pregnancy (now or within last three months)
History of breathing or lung problems
Muscle, joint, or back disorder, or any previous injury still affecting you
Diabetes or thyroid conditions
Cigarette smoking habit
Obesity (more than 20% over ideal weight)
History of heart problems in immediate family
Hernia, or any condition that may be aggravated by lifting weights
Other

 
Monthly payment for each program should be mailed (check or bank draft) to the address listed below:

Samuel HarvellE-mail: samuelharvell@sbcglobal.net
1329 46th AvenueOffice: 415-681-7908
San Francisco, CA 94122Cell: 415-726-4487
415-726-4487