E-Focus

1. Title

2. First Name *

3. Last Name *

4. What is your gender?

Female Male Other (please specify)

5. Date of Birth

6. Email Address *

7. Mobile Number *

8. Address

9. Postcode

10. How did you first hear about us? *

Referred by a Friend Current Member Website Search Engine Social Media Radio Leaflet Signage Advertising Referred by a Member Event Other

11. What facilities/activities are you interested in?

Gym Swim Studio Classes Family Activities Other (please specify)

12. What's your number one fitness priority? *

Weight Loss Improve Fitness Tone Up Improve Strength Health Improve Flexibility Improve Confidence Reduce Stress Improve Posture Increase Energy Levels

13. Please enter any additional information

14. Are there particular areas of your body you would like to improve or strengthen?

Shoulder Arms Legs Bottom Abs Back All Over None of the Above Other (please specify)

15. What has encouraged you to enquire today? *

Holiday Wedding Social Event Sports Fixture Fitness Event Other (please specify)

16. Additional information (Encouragement)

17. Have you exercised recently? *

No Currently Exercising Last Week Last Month A Month Ago or Longer Last Year or Longer

18. Additional Information (Recent Exercise)

19. Are you a member elsewhere? *

Yes No