First Name:
Last Name:
E-mail:
Phone Number:  
What benefits would you like to enjoy?
(check all that apply)

Lose/Maintain Weight
Somerset's Biggest Loser
Improve Health
Improve Strength
Feel Better
More Energy
Reduce Stress
Meet New Friends

How did you hear about our club?
(check all that apply)

Internet Search
Close to Home
Close to Work
Newspaper
Referral
Other

What amenities will you utilize most?
(check all that apply)

Nutritional Consultation
Resistance machines
Personal Training
Free-Weights
Cardio
Kidz Korner
Group exercise

Are you currently exercising?

Yes No

Have you ever been a member of a health club?

Yes No

If so,
what club?

Are you prepared to make a commitment to exercise 1+ times per week?

Yes No