Name:

E-mail:

Phone Number:

What is your goal?

Losing weight

Relaxation

Improving stamina

Social contacts

How often are you willing to work out?1/2 times per week 2/3 times per week 3/4 times per week As often as needed

How often do you think you need guidance?Every time Once a week Once a month I don't need help I would like to be advised by you

Do you want to lose weight? If so, how many kg?1-3 KG 4-6 KG More than 6 KG Losing weight is not my goal

Have you been member of a gym before?No, i have never been member Yes, i have been a member before Yes, i am a member somewhere else now

Ik vind het goed dat mijn gegevens worden opgeslagen om mij te benaderen voor de (start)informatie.

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