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Prospective Member Survey
Thank you for visiting the Health Club at Southpointe's website. One of our Membership Concierges would be happy to send The Club's current promotions and programming. Please complete the questionnaire below and the information will be sent to you by e-mail, mail, or by phone.


If you would like a FREE 7-DAY PROSPECTIVE MEMBER PASS to the Club, please click on the button at the end of the survey. We look forward to seeing you soon!

Contact Information
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Postal Code:
How should we contact you ?
Phone Number:
Email Address:
To better service you, please answer the following questions
How did you hear about us? Internet
 Friend or Club Member
 Direct Mail
 Phone Book
 TV/Radio
 Print
 Other
If 'other', please explain
Have you visited our Club before? Yes   No  
Are you presently exercising? Yes   No  
What types of activities do you prefer?
(select all that apply)
 Group Fitness
 Weight Training
 Cardiovascular Activity
 Personal Training
 Yoga/Pilates
 Spinning
 KidZ Activities/Programming
What are your primary fitness goals?
(select all that apply)
 Weight Loss
 Appearance
 Health Concerns
 Injury Rehab/Prevention
The KidZone Nursery is available for 2 hours daily,
7 days/week for children aged 8 weeks to 8 years. Are you interested in utilizing this FREE service?
 Yes  No
What time of day are you most likely to use the Club? Early Morning 5am-9am
 Mid/Late Morning 9am-12pm
 Afternoon 12pm-4pm
 Early Evening 4pm-7pm
 Late Evening 7pm-10pm
Are you over the age of 18? Yes   No  
On a scale of 1-10,
(10 - Interested), how serious are you about getting started?
Please use the space for addtional questions or comments.

SEND REQUEST FOR YOUR FREE 7-DAY TRIAL PASS
  

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The Health Club at Southpointe
1001 Corporate Drive
Canonsburg, Pa 15317
www.clubsouthpointe.com
724.597.0014

 Local Time: 9/7/2010 12:41:14 am E.S.T. Contact The Health Club at Southpointe: Eugenia@clubsouthpointe.com 
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