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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Are you currently a member of the West U Recreation Center?*

    1. Yes
    2. No
15. If you are not a member, what could encourage you to join?
17. How many times per week do you visit the rec center? *

    1. 0
    2. 1
    3. 2
    4. 3
    5. 4
    6. 5+
19. Which type of fitness equipment do you use? (check all that apply)*

    1. Cardio
    2. Free Weights
    3. Resistance Machines
    4. Accessory Equipment (mats, exercise balls)
    5. None
21. Is there any other equipment not shown in the renderings that should be considered?*
23. Additional comments or questions:
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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