Submitted by ahs-admin on Wed, 02/28/2018 - 22:01 You must have JavaScript enabled to use this form. Member Name: * First Name: First Name: Last Name: Last Name: Other Name Date of Birth: MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year1935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Year Phone Number: Email: * Personal training interest (check all that apply): Strength training Aquatic training in pool Balance / Core training Weight management Cardiovascular training Flexibility training Pilates Reformer training (Tyler location only) Private swim lessons Choose a Location: * - Select -TylerLake PalestineJacksonvillePittsburgCedar Creek LakeHide-Away-LakeRuskChandler Time of Day: Morning (6a.m. - 11a.m.) Midday (11a.m. - 4p.m.) Evening (4p.m. - 9p.m.) Training session duration: 60 minutes 30 minutes Days for training: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Please list any specific needs that should be considered when selecting the proper trainer. (high blood pressure, diabetes, cardiac therapy): What are your main goals to accomplish through personal training? Leave this field blank Submit
