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Please fill out the information below

1. Member Information

Title *
First Name *
Last Name *
Mobile Phone*
Email Address *
Date of Birth*
Street Address*
How did you hear about us?*
Emergency contact name*

2. Health Questionnaire

Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
Do you ever experience unexplained pains in your chest at rest of during physical activity / exercise?
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity / exercise?
Do you have any other medical conditions(s) that may make it dangerous for you to participate in physical activity/ exercise?
**Once we receive your application form, we will contact you to arrange payment and your first visit