GREAT SUMMER PACKAGES NOW AVAILABLE!
3 week sessions for as LOW as $87.50 per month!
Register Now!

GO Fit Registration
Thank you so much for registering for one of our GO Fit Austin programs.  Congratulations!  You have made the first step to feel better about yourself and your body! Please fill out the following form.  This will help us to learn a little about you to make your GO Fit experience the best it can be.  Feel free to e-mail us at info@gofitaustin.com.

Contact Information
First Name:
Last Name:
Address:
City:
Zip Code: (5 digits)
Phone:
E-Mail:
Date of Birth::
How Did You Hear About Us?:
Emergency Contact
Name:
Relationship:
Phone:
My GO Fit Program
Class Dates, Times and Locations:
Is this a multi-month package?
No
  Yes
If yes, please list summer months, and preferred time. 
  Newbie (New to GO Fit)
  Veteran

Pick your Package: 1 Month ($125 Veterans, $150 Newbies)
  2 Months ($115 per month)
  3 Months ($100 per month)
  4 Months ($87.50 per month)
  GO Fit Entercom (employees only)
GO Fit Quick: (If so, July 4th Pump or Labor Day Pump?)
Recruiting Friends? If so, please list names so you are credited.

Please Note:  If you are a returning veteran and your Health History has not changed, there is no need to fill it out again. Please make sure we have it updated in 2010.
Health History(Please check all that apply and answer any questions that pertain to you.)  **GO Fit recommends consulting with a physician prior to participating in our fitness program.
  I am allergic to certain medications.
Explain:
  I am currently taking prescription medication.
Explain:
  I have been told by a doctor that I am anemic.
When and What Treatment:
  I have had or currently have high blood pressure.
List any medication:
  I have a seizure disorder (epilepsy).
  I have been treated for diabetes.
List any medications:
  I have been told by a doctor that I have asthma.
List any medication:
  I have been "knocked out" or become unconscious in the past three years?
Describe and give dates:
  I have had a neck injury involving bones, nerves, or disks that disabled me for a week or longer.
Explain:
  I have had a broken bone (fracture) in the past two years?
Explain:
  I have had a shoulder injury in the past two years that left me disabled for a week or longer.
Explain:
  I have injured my back.
Type of injury/dates:
  I have back pain (occasionally)
  I have back pain (frequently)
  I have back pain (with vigorous exercise)
  I have back pain (with heavy lifting)
  I have injured my knee in the last two years.
  I have had knee surgery.
Explain:
  I have had a severe ankle sprain in the last two years.
Please tell us of any other conditions we should be aware of (i.e. ulcers, pregnancy, food or insect allergies, tendinitis, etc.):


Other Information
Comments:
The questions on this form have been answered completely and truthfully to the best of my knowledge.
Payment

How will you be paying?
Cash
  Gift Certificate

Check

(Please make checks out to GO Fit and mail to 7313 Brecourt Manor Way, Austin, TX 78739.  If within 5 days of start date, bring to first day of class.)

  PayPal using e-mail address info@gofitaustin.com
 
HOT SUMMER SPECIALS! (June-September 2010)

Pick a Package:
1 Session- $150 Newbies/ $125 Veterans 
2 Sessions- $115 Per Month ($230 for 6 wks)
3 Sessions- $100 Per Month ($300 for 9 wks)
4 Sessions- $87.50 Per Month ($350 for 12 wks)

*Summer Special Requirements: 
- Valid for June, July, August, and September 2010 only.
-Each session is 3 weeks, Monday through Thursday for one hour each day.
- Must pay in full on first day of class.  
-Payment options available on request.  GO Fit will hold checks for multi-month packages.
-Multi-Month Packages are intended for individual use, and can not be split amongst partners, friends, etc.
-Pro-Rating NOT available.  Set rate for Summer is $15 per class, or individuals can purchase a punch card. 

GO FIT Punch Cards: (Valid for 6 months)
20 Class "punch" Card - $250
10 Class "punch" Card - $150 

I am ready to
GET OUTSIDE and GET FIT with GO FIT!

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