QUESTIONNAIRE for the book “MAKE NO MORE EXCUSES”
How would you like to help motivate another human being in need? I would like for you to share your story about why you choose to lead a health lifestyle, even in the face of the daily rigors of your busy life. This story could very well end up in a book in my motivational series Make No More Excuses!
This is not about chiseled abs or body building. This is about every day individuals who stay fit in spite of their daily routines and responsibilities. Copy this section and paste it into a Word file.
Do it, then email it to ToxicFree@hotmail.com or snail mail to ATTN: Lance Austin, P.O. Box 26403, Austin, TX 78755 after you complete it. Thank you for participating! Please, CIRCLE the category below for which you are applying with your submission! Should you be chosen to participate and be included in one of these books, you will be contacted prior to publication and receive an autographed copy of the publication in which you are featured. PLEASE, tell all your friends!
Women and Pregnancy - Elderly/Over 50 - Corporate America - Married Couples/Relationships - Handicapped Teens - 20's - 30’s - 40’s
Name:___________________________________________________
(NOTE: You do not HAVE to use your ‘real’ name (or simply your last name) if you do not desire either to be published. Make No More Excuses can utilize only your first name if you choose. Please, write your full name here, and then at the bottom when you sign the release, note the name(s) you desire for disclosure in the book.)
Address:_________________________________________________
________________________________________________________
(NOTE: Your address, phone number(s) and email address will NOT be utilized in any means of marketing nor given or sold to any marketing company. Make No More Excuses will not release any personal information without your express written consent. All subjects, customers, clients and visitors of www.AbsForLife.Com and the book(s) Make No More Excuses are confidential and not released to the general public unless the subject, customer, client and/or visitor authorizes such a disclosure!)
Phone #(s) (include area code)________________________________
Email:___________________________________________________
Birthday: MO________DAY________YEAR:___________________
Spouse's Name (if applicable): ________________________________
Birthday:________________________________
Kids names/ages/genders:____________________________________
________________________________________________________
________________________________________________________
Home City/State:___________________________________________
Educations/School/Degrees:___________________________________
________________________________________________________
Occupation:_______________________________________________
Hobbies:_________________________________________________
Specialties:_______________________________________________
The following questions are to be written in essay format. Do not be afraid to be redundant. Answer in as much detail as possible and elaborate as much as you desire.
- Give your fitness story. Everything you desire about your life and fitness, if you want to market yourself (own website, business, etc.) do so here.
- Discuss your fitness regime pre/during and post pregnancy.
- Tell about your past, where you grew up, your family, etc.
- What made you get into fitness/nutrition?
- Explain your fitness goals, regime, workout. Be detailed.
- Are there any special circumstances (work, kids or otherwise) that makes fitness difficult to keep up with?
- Reason(s) why these circumstances/variables or excuses do not keep you from striving to be fit and from maintaining a healthy lifestyle?
- Are there any family/medical history (genetics/medical conditions/family history/etc.) that requiring a fitness program (i.e. ‘fat’ genetics, heart conditions requiring a walking regimen, etc.)
- Name and elaborate on any inspirations (people/events or otherwise) which caused you to start/continue fitness/nutrition.
- Long term goals for health and well being?
- Elaborate on your diet/eating habits, how this diet affects your family and children.
- Inspirational message to pass on to others?
- Write any and all you desire that has not been covered previously.
THANK YOU for participating!!!
Please send me a note that gives any referrals of others who fit any category that follows: Women and Pregnancy - Elderly/Over 50 - Corporate America - Married Couples/Relationships - Handicapped - 30’s - 40’s
Release and Disclaimers
I, (print your full name here) understand and give consent and permission to Make No More Excuses and Lance Austin to utilize my name, story, and all materials freely offered by me for the book Make No More Excuses. I further understand that this is a motivational book for profit and I expect no compensation of any kind from proceeds that this book or subsequent books generates. I authorize Make No More Excuses and Lance Austin full use of my information in the contents of the book Make No More Excuses, subsequent marketing material and related web sites of said book and organization. I contend that all material provided by me is accurate and truthful to the best of my knowledge and belief.
Print Your Name Here:__________________________________________
Sign Your Name Here:__________________________________________
Date:______________________
I, (Print your full name here) DO Authorize DO NOT Authorize Make No More Excuses and Lance Austin to use my real name in the book Make No More Excuses and any subsequent books, marketing material or related web sites. (If you DO NOT authorize the use of your real name(s), Please fill out and sign below)
Print the name(s) that you authorize Make No More Excuses to utilize in the book Make No More Excuses and any subsequent books, marketing material or related web sites:
NAME(S):__________________________________________________
___________________________________________________________
___________________________________________________________
Signed:______________________________________________________
Date:_____________________
