You are on page 1of 1

JOM FIT BIGGEST LOSER 2.

0
PERSONAL DETAILS (Filled up by participants)

NAME :

AGE :

I/C :

GENDER :

OCCUPATION :

ADDRESS :

TEL. NO :

EMAIL ADDRESS :

MARITAL STATUS :

FITNESS AND BODY ANALYSIS (Filled up by instructor)

HEIGHT :

WEIGHT :

BMI :
BODY FAT % :

WEIGHT LOSS :
DESIRED
PROBLEM AREA :

MEDICAL :
COMPLICATIONS
(IF ANY)
Make all payments to: AZIZUL AIZAT BIN ROSLAN (MAYBANK: 166010170012)
Any enquiries please Call/ Whatsapp/ Text HOTLINE: 012-9865292