Address:   City:    Zip:

Phone:  Email:

Are you currently a member of another facility? Yes No

Are you currently involved in  a workout program? Yes No

Do you have any medical conditions? Yes No

Are you interested in ... swimming?  tennis?  fitness?  personal training? group exercise?  cardiovascular training?  triathlon conditioning?

Give us a brief background of your fitness history and goals. 

What is the best time to contact you? Morning Afternoon Evening

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