SIX VILLAGES SPORTS CENTRE

*1. Title

*2. First Name

*3. Surname

*4. Gender

Male

Female

Other/prefer not to say

5. Date of Birth

*6. Email

*7. Mobile Number

8. Address

9. Postcode

*10. How did you first hear about us?

11. What facilities / activities are you interested in?

15. What has encouraged you to enquire today?

16. Additional Information

17. Have you exercised recently?

No

Yes

Currently exercising

Last week

Last month

Last year or longer

18. Additional Information

19. Are you a member elsewhere?

No

Yes

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Section 1 - Contact Details

*1. Title

*2. First Name

*3. Surname

*4. Gender

5. Date of Birth

*6. Email

*7. Mobile Number

8. Address

9. Postcode

*10. How did you first hear about us?

11. What facilities / activities are you interested in?

12. What’s your number one fitness priority?

13. Additional Information

14. Which body areas?

15. What has encouraged you to enquire today?

16. Additional Information

17. Have you exercised recently?

18. Additional Information

19. Are you a member elsewhere?