First Name: Last Name: Gender: Male Female Married or single: Married Single Weight (in lbs): Birthday: mm/dd/yyyy     Height (feet - inches): Where did you first hear about BSN?: Email Address (must be valid .edu): A valid .edu email address qualifies you for Student Planned Performance™ Secondary Email: Current College or University:		Degree/Major: Graduation Date: Month 01 - Jan02 - Feb03 - Mar04 - Apr05 - May06 - Jun07 - Jul08 - Aug09 - Sep10 - Oct11 - Nov12 - Dec   Year 2008200920102011201220132014 Web Site: Phone Number: (000) 000-0000 - - Secondary Number: (000) 000-0000 - - Street: Apt #. City: State: Select A State AAAEAPAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: What is your preferred method of contact? Primary Phone Secondary Phone Primary E-mail Secondary E-mail

PHYSIQUE GOALS:
What is your desired body weight? (in lbs): How much body fat do you wish to lose? 0lb 1 - 2lbs 3 - 5lbs 6 - 8lbs 9 or more lbs How important is this goal to you? 0 - Not Important 1 2 2 4 5 6 7 8 9 10 - Very Important How long have you wished to achieve your goals (i.e. gaining muscle and/or losing body fat)? < 6 months 6 months - 1 year 1-2 years 2-4 years > 4 years What has held you back from achieving your goals to date? (select the most important one) Not enough time (school, work, family) Not enough money Not enough information (unsure what to do) What do you most like about your body? What areas of your body do you most want to change? What time of day do you normally workout? Before 7am 7am - 9am 9am - 11am 11am - 1pm 1pm - 3pm 3pm - 5pm 5pm - 7pm 7pm - 9pm After 9pm		How much lean muscle do you wish to gain? 0lb 1 - 2lbs 3 - 5lbs 6 - 8lbs 9 or more lbs How important is this goal to you? 0 - Not Important 1 2 2 4 5 6 7 8 9 10 - Very Important Over what time frame do you want to achieve your goals? 1 month 2 months 3-5 months 6-8 months 9 or more months How serious are you about achieving your goals in this time frame? 0 - Not serious 1 2 2 4 5 6 7 8 9 10 - Very Serious If a Performance Specialist were to get you started on Student Planned Performance™ today, is there anything or anyone holding you back? What dietary supplements are you currently using? How would you rate your ability to plan a dietary supplement program? Beginner Intermediate Advanced How would you rate your ability to plan a workout routine? Beginner Intermediate Advanced
Are you part of any extracurricular activities or intramural sports at your school? You and your team may qualify for free gifts and additional discounts!		Would you be interested in competing in BSN's upcoming contest, Mr. & Ms. University Student Body? (starting in 2007) Yes No
Student Planned Performance™ simplifies your life and accelerates your progress. How so? A sports nutrition-certified Performance Specialist will ensure that your BSN supplements are shipped approximately every thirty (30) days. To start simplifying your life and accelerating your progress, please take a moment to provide us with a few more pieces of information.
What credit card will you be using to establish your Student Planned Performance™ account? Mastercard Visa American Express Discover When do you want to sign up for Student Planned Performance™? YESTERDAY!! Today Tomorrow		How much are you willing to spend each month on BSN supplements? $50-$100 per month $100-$150 per month $150-$200 per month $200-$300 per month $300-$500 per monthh More than $500 per month What is the best time of day for a Performance Specialist to call you? (Eastern Standard Time/Miami, FL) Morning Afternoon Evening
If you wish to be contacted by BSN via your e-mail in order for BSN to provide you with special offers on BSN products, to share news with you or a combination of the two please check this box (opting in). If you do not check this box you will not receive periodic e-mails from BSN.
Term Conditions and Reminders 1. Any changes to your monthly order must be received at least 72 business hours prior to your next shipment date. This includes 30 day freezes, cancellation requests or changes to your shipment (i.e. removing a supplement from your order or flavor changes). Requests for freezes, cancellations or changes are not accepted via e-mail or voice mail. Please direct all requests to our customer maintenance department toll free at 877-673-3727 x210 from 8am till 5pm, Monday thru Friday. 2. Due to the fact that BSN Planned Performance members will receive special discount pricing, promotional offers and gift sets, all Planned Performance purchases are non refundable. Depending on the circumstance a BSN product credit may be issued but must be approved by a supervisor. 3. Claims for damaged product must be made within 48 hours of their receipt. 4. With each order you will collect valuable BSN rewards points. BSN rewards points will become available for exchange of free BSN products once you have completed a full 16 weeks cycle. The only way you can loose BSN Rewards points is if the membership is canceled. 5. Please make sure to supply BSN with up to date shipping and billing information if you move residence or would like to have your shipment sent to an additional address. Many times clients will experience delays in delivery because they forget to call in a new credit card after their old card has either expired or unfortunately been misplaced or stolen. Credit card authorization will be done with the CV2 code on the back right of the card to insure efficacy.
I have read and agree to the above Rules & Regulations: