I would like to receive a FREE TRIAL VISIT What membership categories and costs are there? Other Question (please type here)   ABOUT YOU (You must complete all sections in this box) Mr Mrs Miss Ms Surname: First name(s): Address: Postcode: Tel. Day: Tel Eve: Email: Please complete these questions so we can assist in finding the best membership for you (Optional) ACTIVITY HISTORY Are you currently exercising? Yes No If yes, are you a member of a gym? Yes No If no, when was the last time you exercised on a regular basis? 3-6 months 6-12 months 1-2 years 2-5 years 5years + never How would you describe your level of fitness? WHAT ARE YOUR PERSONAL GOALS? Please tick as many boxes below as are important to you. Appearance benefits: Performance benefits Tone / firm Balance symmetry General weight loss Body shaping Improve posture Weight gain Specific fat loss Healthy look Strength Endurance Competitive edge Speed Flexibility Co-ordination Rehabilitation Energy levels Health benefits Social benefits Relieve stress Improve breathing Improve quality of life Improve sleep Improve general health Improve circulation Increase range of motion Meet people Something new Relaxation Confidence Have fun Something for yourself Achievement General well being OVERALL What is your number one priority? When do you want to start? GENERAL How long have you been considering starting an exercise programme? Has anything in particular stopped you from starting sooner? Work No time Family commitments Procrastination Money Injury         Is this still a problem? Yes No What is your age?  18-25 26-35 36-45 46-55 56+ MARKET RESEARCH How did you hear about Dunnings Heath & Fitness Club? Sign / banner Recommendation Internet Leaflet Letter mailing Newspaper Yellow Pages Radio Corporate     Will this be your first visit to Dunnings Health & Fitness Club? Yes No