12 Rounds of Boxing Fitness - Free Trial Class Form

Free Trial Class Registration Form
(Must be 18 years of age or older)
First Name: *
Last Name: *
E-mail: *
Phone: *
Preferred Contact Method *	E-mail Phone
Address
City
State
Zip

How did you become interested in boxing training?
Have you received boxing training before?	Yes No
What are your primary goals? (check all that apply)	Fitness Learn Boxing Technique Lose Weight Build Self-Confidence Have Fun Other
Please Elaborate

How many times a week do you currently work out?	1-2 3-4 5-7 None
Do you want to lose weight with this membership?	Yes No It Doesn't Matter
How did you hear about us?	Flyer Walk-In Internet Referral Drove Past, Saw Sign

Which class would you like to try out? *
On what date? *
At what time? *