Age:
Your Name:
Your Phone No:
Your email:
Are you currently exercising:
Tell me about any health issues or injuries you have. (please select any that may apply:
IMPORTANT NOTICE: It is wise to seek your doctor’s advice before beginning any health/fitness/nutrition program!
With doctors and physician support, are you able to participate in an exercise program? 



 
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REGISTRATION FORM
Choose your preferred session times (min. 2 Sessions):
*This Discounted Offer only applies to new members taking up the above Program
Choose your preferred payment plan. 
Direct Debit will incur a $2 transaction fee.
PAYMENT METHOD
Option 1
Option 2
Weekly Direct Debit
Payment in FULL - pay 11wks - get 12th FREE
SAVES
$60
Add a M'ship for unlimited Not a Gym Classes
Health & Fitness Questionnaire
Not at allA couple times p/wk2-3 times p/wk3+ times p/wkMost days
High Cholesterol
High Blood Pressure
Heart or Lung Conditions
Hernia
Arthritis
Asthma or respitory proplems
Seizure Disorder
Diabetes
Back Pain
Neck Pain
Joint Issues or limitations
Recent Broken Bones
Recent Surgery
Recent Injuries
Muscular Disorders
Other:
YES. Click to agree... & type your name:
Pregnant or given birth recently
Any infectious Diseases
Take prescribed medication
Heart or Lung Condition
SAT 7am
TUE 5.45am
THU 5.45am
TUE 7.30pm
THU 7.30pm
x3 Sessions a week @ $12 ea = $36pwk
x2 Sessions a week @ $14ea = $28pwk
x3 Sessions a week @ $12 ea = $396
x2 Sessions a week @ $14ea = $308
$155 *12wk Not a Gym Membership