membership

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Address

Yes, subscribe me to your newsletter.

Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?

Yes

No

Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?

Yes

No

Do you ever feel faint, dizzy or lose balance during physical activity/exercise?

Yes

No

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?

Yes

No

If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?

Yes

No

Do you have any other conditions that may require special consideration for you to exercise?

Yes

No

Upon completion of your orientation, a one-time, refundable fee of $25 will be processed for your access fob.

Gym Memberships