Full Name
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First Name
Last Name
E-mail
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Phone Number
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Area Code
Phone Number
Location Interested
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Please Select
Anchorage - Old Seward
Anchorage - Midtown
Eagle River
Wasilla
Do you currently belong to a health club?
Yes
No
If so, which one?
How did you hear about us?
Please Select
Television
Radio
Newspaper
Direct Mail
E-mail
Internet Search
Friend
Club Employee
Walked/Drove By
Other
Tell us about your fitness goals:
Weight Loss
Muscle Tone
Weight Gain
Muscle Increase
Increased Energy
Increased Flexibility
Injury Rehabilitation
Relieve Stress
Sports Performance
Increase Endurance
Are you interested in Personal Training?
Yes
No
Are you interested in Group Fitness?
Yes
No
What is most important to you in a health club?
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Other Feedback? Comments, Questions, Suggestions, etc.
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