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Antioch – Pedersen Park
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Brenda Umphress
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Instructions:
We are just as excited about your upcoming fitness program as you are. However, before we can start making you sweat, beg for mercy, and transform that thing you call a body, we're going to need some information to help us get you scheduled as quickly as possible. The information provided will help to make your experience with us productive and memorable. Once your registration data is received, you will be notified 3-5 days prior to the beginning of the month you selected. Anytime 10 card holder privileges allow for you to attend classes at your convenience. Remember, all classes except Anytime 10 start at the beginning of the month and finish at the end of the month.
Date
Date of Registration
First Name
*
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Last Name
*
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Address 1
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Address 2
Do you have a apt, unit, or suite number?
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Phone Number
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Email Address
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Confirm Email Address
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Age
*
<20
20-29
30-39
40-49
50+
What is your age group?
Gender
*
F
M
Intensity Level
*
Beginner
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Other
Which program are you interested in?
Location Interest
*
Libertyville (Old School FP) PM
Mundelein (Indoor Nov.- Mar.)
Chicago (Belmont Harbor)
Vernon Hills (Century Park) AM
Antioch (Pederson Park) AM
Which location are you interested in?
Referral Status
*
Gift Certificate
Groupon
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Start Date
*
When would you like to start with us?
Voucher Number
What is your voucher number if using Groupon , Living Social, or Coupons?
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