FREE TRIAL CLASS

Please complete this brief form before claiming your free trial class

Sex:

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First Name:

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Address:

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How did you hear about us?

	Radio Ad		Internet Search		Magazine		Other (please specify)
	Mobile/Lawn Sign		Passing By		Word of Mouth		Member Referral

Who referred you?

Are you currently involved in a regular fitness routine?
Yes No

If No, how long have you been without a regular fitness routine?
Less than 6 months 6 months to 1 year More than 1 year

What are you looking for in a fitness program?
Energy Weight Loss Improve Cardio Muscle Toning
Strength Flexibility Stress Relief Group Training

What area of your body would you like to target most?
Abs Arms Back Chest Hips Legs Shoulders Glutes

Would you be able to set aside 1 - 3 hours per week to workout?
Yes No

What obstacles interfere with maintaining a regular fitness routine?
Motivation No Time Children Other (please specify)

In the BOXING method of fitness where do you think YOU fit in?
Beginner Intermediate Advanced

What day would you like to come?

Name of class or class time you would like to attend.

Would you like to be contacted?
Yes No