About You

* First Name:
*Last Name:
*Phone:
*Email:
Birthdate:	Enter in MM/DD/YYYY format
Business Partner Contacts:	Use the text box below to provide the contact information for all other legal parties responsibile for this affiliate.

About Your Affiliation

*Proposed Affiliate Name:
Legal Business Name:
*Billing Street:
*Billing City:
*Billing State:
*Billing Zip:
*Billing Country:
Website:

Your Gym

Please provide as much information regarding the location of your gym as possible.

Street Address:
*City:
*State/Province:
Zip:
Country:

Certification

Have you been certified?:	YesNo
When?:	Enter in MM/DD/YYYY format
Where?:
What Level?:	--None--Level 1Level 2Level 3
Do you subscribe to the CrossFit Journal?:	YesNo

*Affiliate Application Essay:

Explain what CrossFit means to you, why you want to become a CrossFit affiliate, and what you want to achieve as an affiliate. This essay does not need to be long but it should be from the heart.

Also, please include:

• Background information on yourself and any of the people you will be partnering with.
• Information on your exposure to CrossFit (work at or exposure to other CrossFit facilities, length of time training with CF methods etc).
• Information on past or future CrossFit events you have attended or plan on attending.
• If you will be a CrossFit Only facility or if you will offer other types of Fitness classes.