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We would like to help you get started, please complete the form below with as much information as possible.

Choose Your Leisure Centre

Section 1 of 3 - Contact Details

*1. Title

Mr

Mrs

Ms

Miss

Dr

Child

*2. First Name

*3. Surname

*4. Gender

Male

Female

5. Date of Birth

*6. Email

*7. Mobile Number

8. Address

9. Postcode

*10. How did you first hear about us?

Website

Referred by a member

Facebook

Instagram

Twitter

Banner

Leaflet

Corporate

Event

Signage

Referred by GP/Physio

Newspaper/Mag advert

Radio

11. What facilities / activities are you interested in?

Gym

Swim

Studio Classes

Family Activities

Other

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Section 2 of 3

12. What’s your number one fitness priority?

Weight loss

Improve fitness

Tone up

Improve strength

Health

Improve flexibility

Improve confidence

Reduce stress

Improve posture

Increase energy levels

13. Additional Information

14. Which body areas?

Shoulder

Arms

Legs

Bottom

Abs

Back

Other

All over

None of the above

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Section 3 of 3

15. What has encouraged you to enquire today?

Holiday

Wedding

Social event

Sports fixture

Fitness event

Other

16. Additional Information

17. Have you exercised recently?

Less than 4x per month

5-8 times per month

9+ times per month

Not at all

18. Additional Information

19. Are you a member elsewhere?

No

Yes

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