DFR Intake-Survey

Diet Force Recon Intake Form
Please answer the following questions to continue with DFR offered products and services.

What is your name? (Or the name that you go by)*

Clear selection

What is the best way to contact you?*

Clear selection

What is your interest in Diet Force Recon?*

Clear selection

How did you hear about Diet Force Recon?*

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What manner of involvement are you interested in?*

Clear selection

How soon are you interested in starting?*

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Are you representing yourself or a group?*

Clear selection

Do you have any special needs or accommodations?*

Clear selection

Will you need assistance obtaining equipment required for coursework?*

Clear selection

When attending in person classes, will you need transportation assistance?*

Clear selection

Are you (or any affiliated parties) intending to make a contribution?*

Clear selection