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 Year1934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 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
