Fitness On The Go Request

Contact Information

First Name *

Last Name *

Email Address *

Phone Number *

Group Information

Group Name *

Number of Anticipated Participants *

Event Information

Type of Event (check multiple if desired) *

Group Exercise Class

Presentation

Blood Pressure Screening

Body Composition Screening

Name of Preferred GX Class/Presentation (if applicable)

Desired Date *

Month

Day

Year

Desired Time *

Alternate Date *

Month

Day

Year

Alternate Time *

Additional Details

Please provide any additional details you feel will be helpful:

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