Welcome

Welcome:  USA Map Health Club /Gym:   Texas Health Club/ Gym:  Amarillo Health Club/Gym Request Form:

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Personal Fitness  History
Do you currently exercise?

yes
no

If Yes, Please select type of exercise you are currently involved in:

Aerobics activities Aquatic activities Circuit Training Aerobic Dancing
Cycling Kickboxing   Walking Group Sport Activities

How would you rate your normal day-to-day activity Levels

Daily Activity Level  

 
 

Health Club History
Have you ever had a Gym Membership? NO     YES
If Yes, For how long?
Do you currently have a membership at a Gym? NO     YES
If yes, for how long have you been a member there?
Are you training for a specific event, occasion or sport?
 		 NO    YES, Describe:
What are the most convenient days and times for you to come to the Gym?

(You may select several by just  CONTROL-CLICK)
What days and times are you not able to come to the gym?
 

Basic Information
Name:    State          City    
E-mail:
Phone # to Contact You
Best Time to be