Name *

First Name

Last Name

Phone *

(###)

###

####

Are you interested in attending group fitness classes?

yes

no

maybe

What are your fitness goals/interests? (check all that apply) *

getting stronger

gaining mass/definition

losing weight

trying new things

cross training

pre/post Partum

healing from injury

having fun

other

Are you prepared to financially invest in a personal training program at this time? *

yes

no

If you start a personal training and/or nutritional program, will you have the full support of your family/friends/spouse/partner? *

yes

no

not sure