Personal Training Interest Form
First Name:
*
Last Name:
*
Phone:
Email:
*
How do you prefer to be contacted?
*
Phone
Email
Are you a Cooper Fitness Center member?
*
Yes
No
If not, are you interested in joining?
Yes
No
How did you hear about us?
*
Family/Friend
Colleague or Professional Contact
Website Search
Social Media
Email
Direct Mail
Banner/Billboard
Magazine Ad/Article
Newspaper Ad/Article
Radio Ad/Story
Television Story
Other
Please select your fitness goal(s):
*
Weight loss
Improve fitness
Improve functional movement
Day(s) of the week you prefer to exercise: (select all that apply)
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time of day you prefer to exercise: (select all that apply)
*
Early morning (5-8 a.m.)
Mid-morning (8-11 a.m.)
Midday (11 a.m.-1 p.m.)
Afternoon (1-4 p.m.)
Evening (4-8 p.m.)
Trainer preference:
*
Male
Female
No preference
If you prefer to work with a specific trainer, list his/her name:
Please provide additional information or questions.