First Name *

Last Name *

Date of birth *

Email *

Phone *

What branch of military did you serve in? *

Years of Service *

MOS *

I agree to terms & conditions provided by QRF. By providing my phone number, I agree to receive text messages from the organization.

What gyms interest you in your area? *

Limitations/Injuries *

What type of workouts interest you most? *

How many times a week can you train? *

Do you wish to compete in any sport *

Yes

Do you have transportation to and from a local gym? *

Yes

What category do you think best fits your training goals? *

After your 6 month QRF membership what is your monthly financial commitment to staying in shape? *

Do you already have a gym membership? *

Yes

If you already have a gym membership, gym name:

What are your fitness goals? *

What is your fitness experience? *

Would you like nutrition counseling? *

Yes

Do you have any other barriers in your fitness journey? *

Do you need any equipment? *

Is there anything else we should know about your living situation, physical limitations, or motivations for participating in the QRF program? *

Do you consent to participating in anonymous quality of life and health biomarker surveys before, during, and after your time in the QRF program? (This survey is essential for QRF to track program successes and failures as well as justify future grant proposals and program expansions) *

Yes

Please Submit Your Dd214 With Social Security Number Scrubbed Or Blacked Out

DD214 *