Fields marked with an asterisk * are required.

Your Name:*

Your Address:

  (# & Street) 
 (City)
 (state)
 (zip)

Your E-mail Address:*

Your Telephone #'s: *

  (day)*
 (evening) 
 (fax)

If you joined Bodies in Motion, where would you work out?*
                          

What results would you like to see? (check all that apply)
            Lose Weight (How much?)
            Tone up/firm my body
            Build Muscle
            Strengthen my body
            Reduce Stress
            Keep my heart healthy
            Improve my flexibility
            Improve my energy level
            Other
What type of workouts would you like to try? (check all that apply)
            Instructional Fitness Classes
            One-on-One Personal Training
            Boxing
            Kickboxing
            Weight Training
            Cardiovascular Equipment
            Yoga
            Pilates
            RoadRacing (aka Spin)
            Dance Related Classes (Hip Hop, Cardio Swing, Latin Funk, etc.)
            Other
How many times per week do you want to workout?  
How long do you think you'll be able to stay during each visit?   Minutes
Do you workout now?   YES   NO
             If "NO" why not? (check all that apply):
            Didn't go to the gym(s) that I was a member of.
            Not enough money to join a gym.
            Embarrassed about going to a gym
            Haven't had the time to research what's available
            I hate working out! (But know I should be)
            I'm just not motivated enough
            Need more information about what I should do in terms of my workout regimen.
Please select your age group: