Welcome

Welcome:  USA Map Health Club /Gym: Texas Health Club /Gym: Dallas Forth Worth 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
 
If No,
 Please Select type of  services you are looking for in a gym?
         
 Jacuzzi  Indoor Pool  Outdoor Pool Aerobic class  Other  
 Personal Training Massage Child Care   open 24 hours  
 

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 call