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Name (FIrst and Last): * E-mail Address: * Mailing Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming --Territories-- American Samoa Federated States of Micronesia Guam Midway Islands Puerto Rico U.S. Virgin Islands Zip Code: Phone: Sex: M F Wife / Husband Name Childrens Names and Ages Typical Work Week Monday Tuesday Wednesday Thursday Friday Saturday Sunday What are your typical work hours (e.g., 9-5) Training Goals Racing Goals Injury Background Have you had surgery in the last 12 months? Have you had PT for an injury in the last 12 months? If yes, please elaborate Swim (time and distance) Bike (time and distance) Run (time and distance) Heartrate monitor type Indoor trainer type Swim equipment Current running shoe Current bike Training preference Group setting Solo style How much time can you train How much do you want to train? Nutrition I eat out predominately I make my own meals Dietary preference (vegan, gluten-free, etc.) Estimated in-season caloric intake Estimated off-season caloric intake Greatest training fear Greatest racing fear Do you consider yourself mentally strong? Yes No * Required