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Contact Information First Name Last Name Phone Email General Information Do you currently belong to a health club? Yes No What services will you utilize at our club? Personal Trainer Group Personal Training Group Ride (group cycling) Group Power (Full Body Resistance Training) Biomechanical Assessment 4 Week Personalized Fitness Plan How did you hear about JP Fitness? - Select One - Internet Yellow Pages Newspaper Direct Mail Referral Television Radio Club Employee Other Is there anything else you would like to tell us? Fitness Goals What fitness goals do you wish to achieve? Gain weight & build body mass Increase energy Increase flexibility Rehabilitation Relieve stress Increase sports performance Increase endurance Social interaction