Nominate A Club

The below form is a nomination or a request.

IF YOU ARE A MEMBER or INTERESTED MEMBER, please fill out the form below in its entirety – the more information, the better.

IF YOU ARE AN INTERESTED FITNESS FACILITY, please fill out the form as it pertains to your center’s contact information.

*PLEASE ENCOURAGE COWORKERS TO COMPLETE THIS FORM IF THEY ARE INTERESTED AS WELL.*

First Name

Last Name

Phone

Employer

# of Employees at Current Location

Are Other Co-workers Interested?

Partners

Club Name

Club Address

City

State

Zip Code

Club Phone Number

Club Manager Name

Club Manager Email

Club Manager Fax

Club Website

Are You A Member?