Cederdale Health & Fitness
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Trial Membership

Thank you for your interest in Cedardale Health & Fitness. Simply fill out the form below to receive your FREE 3-day BASIC Trial Membership. Note: Trials are for those individuals who are over 16 years old and older and are non-repeatable. The BASIC Membership does not include use of the outdoor facility.
Contact Details
First Name:
Last Name:
Street Address:
City:
State:
Postal Code:
Phone Number:
Email Address:
Let Us Know Your Fitness Goals
Age
How did you hear about Cedardale
(select all that apply)
 Friend
 Past Member
 Direct Mail
 Newspaper
 TV Commercial
 Member Referral
 Phone Book
 Other
Marital Status Single   Married  
Number of Children
Ages of Children
If you have health insurance please indicate plan name
Have you joined a fitness club before?
Are you currently exercising, whether it be at a health club or on your own?
What results do you want to achieve?
(select all that apply)
 Reduce Weight/Body Fat
 Firm Up/Increase Tone
 Improve Self Esteem/Confidence
 Increase Endurance/Fitness
 Improve Energy Level
 Stress Management
 Sports Conditioning
 Flexibility
 Strength Training
 Body Building
 Other
How many days a week?
What time of day would you prefer to exercise?
Areas of Interest (check all that apply):
Fitness Center
(select all that apply)
 Strength Training Machines
 Cardiovascular Machines
 Free Weights
Pool
(select all that apply)
 Water Exercise Classes
 Lap Swimming
 Swim Lessons
 Swim Team / Masters
Court Sports
(select all that apply)
 Racquetball
 Tennis
 Basketball
 Squash
 Competition
 Leagues/Lessons/Clinics
General Fitness
(select all that apply)
 Weight Loss
 Health Education
 Running/Walking
Other
(select all that apply)
 Social Events
 Kidsports/Camps
 Massage Therapy

  

* Bold Fields are Required