Request Membership Price Sheet at Xtreme Couture

	MEMBERSHIP PRICE REQUEST
	LET'S GET STARTED! Fill out the form below and one of our qualified member associates will be happy to schedule an appointment with you and go over your fitness goals, our memberships and suggest the right program for you.

	FIRST NAME *		LAST NAME *

	PHONE *		EMAIL *

	ADDRESS *		CITY *

	ZIP CODE *		STATE *

	AGE GROUP *		GENDER *

	WHAT IS YOUR PRIMARY INTEREST *		HOW MANY DAYS A WEEK CAN YOU COMMIT TO *

	HAVE WOULD YOU RATE YOUR HEALTH *		HOW DID YOU HEAR ABOUT US *

	WHAT ARE YOUR GOALS WITH YOUR TRAINING *

	DO YOU FOLLOW US ON FACEBOOK *		DO YOU WANT EMAIL UPDATES *
	YES NO		YES NO