SXU Employee Registration Form
Personal Training & Nutritional Coaching Sessions
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First Name
Last Name
Sex:
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SXU Employee ID #
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Cougar Card ID number (7 digits, ex. 0123456)
Date of Birth
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Best Contact Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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Personal Training Session
30 minutes
$15.00
$
15.00
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Personal Training Session
60 minutes
$30.00
$
30.00
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Nutritional Coaching
30 minutes
$15.00
$
15.00
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Nutritional Coaching
60 minutes
$30.00
$
30.00
Quantity
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Credit Card Details
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Last Name
Credit Card Number
Security Code
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