The Brady Oberg Legacy Foundation
A Man, Our Hero, His Legacy
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TNT Fitness Program Application
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Veterans TNT Fitness Application
General Information
Veteran First Name
*
Last Name
*
Email Address
*
Phone Number
*
Alternate Phone Number
Adress
City
State
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Date of Birth
mm/dd/yyyy
Military Information
Branch of Service
Army
Navy
Marines
Air Force
Coast Guard
National Guard
Reserves
How long did you serve in the Armed Forces
Job Title
Rank upon separation
Honorable Discharge
Yes
No
Units Served With:
About You
Please tell us about yourself
Do you require any special accommodations?
Do you currently exercise?
Yes
No
Do you have any barriers keeping you from exercising? Please explain:
Can you afford to pay for a gym membership?
Yes
No
Can you afford to pay for a personal trainer?
Yes
No
How much are you able to pay for a gym membership and/or personal trainer per month?
EMERGENCY CONTACT
Emergency Contact
First Name
Emergency Contact
Last Name
Phone Number
Address
City
State
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Relationship
Almost Done!
AUTHORIZATION: By selecting "Yes" below and submitting this application, I authorize the verification of the information on this form as to my military service and allow Brady Oberg Legacy Foundation to contact me at the address and phone number provided:
Authorization:
Yes
No
Are you currently serving in the military:
Yes
No
If No, Please attach a copy of your DD214
How did you hear about this program?
*
