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Member Number Date
Evening Phone
Day Phone
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PERSONAL GOALS (check all that apply)
Economize Workout Time
Improve Posture
Injury Rehabilitation
Improve Flexibility
Improve Cardiovascular
Improve Motivation
Relieve Stress
Tone & Firm
Improve Strength
Gain/Lose Weight
Strengthen Bones
Sport Specific Training
Other

PREFERRED CLUB(S) (check all that apply)

Anchorage