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*E-mail Address:
Daytime Phone:
*First Name:
*Last Name:
*Address 1:
*City/Province:
*State:
*Zip/Postal Code:
Country:
Business Name:
Professional Title:

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*2) Gender
Male
Female

*3) Which title(s) most closely describes your position (check all that apply):
Club Owner
Club Manager
Studio/Franchise Owner
Boot Camp/Group Fitness Owner
Fitness Director/Manager
Independent Personal Trainer
Personal Trainer under Contract with Fitness Facility
Personal Trainer Employed by Fitness Facility
Group Instructor
Athletic Trainer
Fitness or Wellness College Student
Wellness Facility Owner/Manager
Wellness Practitioner
Other (specify):

*4) I have the following certifications (check all that apply):
AAAI
ACE
ACSM
AEA
AFAA
AFPA
Cooper Institute
IFPA
IFTA
ISSA
NASM
NESTA
NFPT
NPTI
NSCA.
W.I.T.S
Other (specify):

*5) Where do you train: (check all that apply)
Client's Home
Own Home
Multi-Purpose Club
Own Studio
Rehab Facility
Educational Facility
Wellness Facility
Outdoors
Other (specify):

*6) Which products do you intend on purchasing in the next 12 months? (check all that apply):
Large Fitness Equipment (strength, cardio)
Business Software/Web Tools
Continuing Education Courses/Certifications
Fitness Accessories (balls, bands, etc)
Apparel & Footwear
Educational Material (DVD's, books, etc)
Pilates/Yoga Equipment

*7) What programs/classes do you instruct if any? (check all that apply):
Boot Camp
CrossFit
Group Exercise
Yoga
Pilates
Spinningtm (Indoor Cycling)
Water Aerobics
Gravity
Special Populations (Youth, Senior Citizens, Athletes, etc.)





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