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MEMBERSHIP FORM
Power Health Club membership to men from age 8 to 80. We also coach athletes and professional body builders.

We also have a corporate membership plan.

If you would like be a member of our health club simply fill out the request form below with correct details.

Name
Telephone
Email
Fax
Your Age
Address
What are you interested in accomplishing?
Losing Weight
Developing Muscle
Improving General Health & Fitness
Normalization Courses
What best describes your workout experience?
Beginner (0-1 days a week, not on a regular basis)
Intermediate (2-3 days a week on a regular basis)
Advanced (4 or more days a week on a regular basis)
Please choose ANY additional areas of concentration on which you would like to focus:
Biceps
Chest/Pectorals
Inner Thigh
Outer Thigh
Triceps/back of arms
Calf muscles
What cardio activities do you enjoy (choose up to 3): (Optional)
Running/Jogging
Walking
Biking
Swimming
Stair Climbing
Group Exercise
Do you prefer to work out with:
Weight Machines (also called selectorized weight machines)
Free weights, body weight or other resistance
How many days a week do you want to work out?
3 days a week
5 days a week
Do you prefer to work out:
With others/in a Group
Alone
Unsure/varies