Name *

First Name

Last Name

Phone *

(###)

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Birth Date *

MM

DD

YYYY

Membership Category *

New

Existing

Membership Start Date

MM

DD

YYYY

The primary reason I'm interested in M2 Fitness is to: *

Lose some weight and some inches

Learn how to stay consistent

Tone and tighten up

Have more energy

Get stronger

Eat better

Be held accountable

Find the time to care for myself

My current nutrition habits are: *

Horrible, help me, please!

Okay...could be better.

Excellent, not a problem at all

My current exercise routine involves: *

Nothing

Exercising 1-2 Times a week

Exercising 3-4 Times a week

Exercising more than 4 times a week

Emergency Contact Name *

First Name

Last Name

Emergency Contact Number *

(###)

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####

Parent/Guardian's Name:

First Name

Last Name

Parent/Guardian Contact Number:

(###)

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*

I have read, understand, and agree to M2 Fitness rules and regulations.