Your Name*
Your Email*
Telephone Number*
Gender* MaleFemalePrefer Not To Answer
Your Age*
Are You Currently a CHI Member?*	Yes	No
If not a member, do you plan on becoming a member?*	Yes	No
Do you have a specific trainer you would like to work with?*
How many days per week would you like to train?* 1234567
How much time would you like to devote to each personal training session?*	30min	60min
What days and times are you available during the week?*
What are your personal goals? What would you like personal training to help you achieve?*
Do you have any concerns or health implications that need to be considered?*
Please expand on your current number of days, type of activities and length of time you spend on current exercise sessions.*