First Name: Last Name: Gender: Male Female Married or single: Married Single Weight (in lbs): Birth date: mm/dd/yyyy     Height (feet - inches): Where did you first hear about BSN?:		E-mail Address: Web Site: Direct/Cell Phone Number: - - Street: Apt #. City: State: Select A State AAAEAPAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code:

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 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 Do you currently work with a nutritionist? yes No		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 Pro Planned Performance™ today, is there anything or anyone holding you back? What dietary supplements are you currently using? Are you currently working with a certified trainer? yes No
What sport do you have professional status in?		Can you please provide us with either professional identification number and association or a website link that displays a current roster listing, team or personal home page?
What credit card will you be using to establish your Pro Planned Performance™ account? Mastercard Visa American Express Discover How soon would you like to purchase your first Pro Performance Supplement Stack? YESTERDAY!! Today Tomorrow How often do you check your e-mails? Daily Every other day Once per week Less than once per week Never		If presented with a similar program, do you think additional athelets or teammates would like to enjoy these health & fitness benefits with you? Yes No If so, how many?
BSN stacks are intended to last 12-16 weeks. As a member of Pro Planned Performance you will receive a specific purchase price. Would you rather purchase your product for an entire season at once or budget a monthly allotment to be automatically debited from a credit card every 30 days? Many times athletes that travel frequently will buy their entire seasons worth of product in one large purchase. Athletes who tend to be "home- based" typically have 30 day dosages automatically billed & shipped every month to their home.
1 Full Season 30 Day Dosage Every Month
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. 6. DISCLOSURE - Any athlete, agent or user of this website should consult their professional association for specific details as to whether BSN, Inc.’s products are suitable for the athletes, agents or users respective professional association. No athlete, agent or user should rely solely on the advice or the written materials contained on www.bsnonline.net.
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