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TNT Fitness Program Application

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Name

Veterans TNT Fitness Application

General Information

Veteran First Name *

Last Name *

Email Address *

Phone Number *

Alternate Phone Number

Adress

City

State

Zip Code

Date of Birth

mm/dd/yyyy

Military Information

Branch of Service

How long did you serve in the Armed Forces

Job Title

Rank upon separation

Honorable Discharge

Yes

Units Served With:

About You

Please tell us about yourself

Do you require any special accommodations?

Do you currently exercise?

Yes

Do you have any barriers keeping you from exercising? Please explain:

Can you afford to pay for a gym membership?

Yes

Can you afford to pay for a personal trainer?

Yes

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

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

Are you currently serving in the military:

Yes

If No, Please attach a copy of your DD214

How did you hear about this program? *

Defender Dash

10th Mountain Devision

Hey UND Students!!

Make sure you check out the Brady Obery Legacy Scholarship offered to current UND students.
CLICK HERE for more details.

Our Story

Learn about Brady Oberg and the formation of his legacy foundation.

September 2018
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