Membership Pre-Application

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Email Address:
Daytime Phone:
Evening Phone:
Are you currently exercising? Yes No
If so, what are you currently doing?
Have you ever been a member of a health club? Yes No
If so, what club?
What were your likes and dislikes?
Are you prepared to make a commitment to exercise 3+ times per week? Yes No
What areas are you most interested in at our club? Classes Free Weights Yoga Spinning Basketball Raquetball/Squash Cardio Equipment Childcare Other
Name of friends/family you would like to get fit with:
How much time will you be devoting to a healthier lifestyle per week?
Can you set aside $12 a week for your exercise program? Yes No
Would an improvement in your health affect your family? Yes No
If yes, how?
How would you rate your overall health?
What areas of your body would you like to focus on? Waist Hips Thighs Chest Arms Glutes
 On a scale from 1 to 10 (10 being most important), please rate the following:
Safety 1 2 3 4 5 6 7 8 9 10
24 Hour Access 1 2 3 4 5 6 7 8 9 10
Sunday Access 1 2 3 4 5 6 7 8 9 10
Tanning 1 2 3 4 5 6 7 8 9 10
New Equipment 1 2 3 4 5 6 7 8 9 10
Personal Trainer 1 2 3 4 5 6 7 8 9 10
Shower Facilities 1 2 3 4 5 6 7 8 9 10