Name	:
Age	:
Res. Add	:
Contact no	:
E – Mail ID	:
Do you have any medical history or any existing problems? Yes No
If so please specify:	:
How did you hear about us?	:
Have you been a member of a health club in the past? Yes No
If so, which one?	:
What fitness goals would you like to achieve? (Please tick on appropriate boxes )
Weight Loss Weight Gain Body toning & shaping Muscle Building General Fitness
Others please specify	:
How much time do you plan to commit each week to achieve these goals?
	:
Exercise History
Have you worked out in any health club before? Yes No
If so, how long back was that?	: