Challenge Form

FUSION MMA & KICKBOXING

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Fusion Questionnaire

Fill out this short questionnaire so we can better help understand your needs. Afterwards we'll hop on a call to go over any questions you have and see if our program is a good fit.

If it is, you can get an extra week FREE when you register on our call!

* Indicates required field

Name *

First

Last

Phone Number *

Gender *

Male Female

My goals are *

Weight Loss Self Defense Strength & Conditioning Improve Confidence General Exercise Other

I am interested in *

Fitness Kickboxing Brazilian Jiujitsu Circuit Training Muay Thai & MMA

Are you willing to start in the next 7 days? *

Yes No

Are you willing to train 3x per week to accomplish your goals? *

Yes No

Do you prefer morning or evening sessions (or both)? *

Morning Evening Both

What would you like to accomplish in 6 weeks of training? *

What has stopped you from reaching those goals? *

Submit

Fusion MMA & Kickboxing
600 North Bicycle Path
Port Jefferson Station, NY 11776
Phone: 631-828-8008

Home
Fitness Classes
MMA & Jiu Jitsu
- Brazilian Jiu Jitsu
- Muay Thai
Kids Martial Arts
Instructors
Contact
Schedule