Fitness Center at UH Avon Health Center

Request Membership Information

Thank you for your interest in the Fitness Center at University Hospitals Avon Health Center. If you would like to learn more, please fill out the following questionnaire:

Personal Information

First Name:*

Last Name:*

Street Address 1:

Street Address 2:

City:

State:

Zip:

Email Address:

Home Phone:

Cell Phone:

Employer's Name:

How did you hear about us?

If referred by member, please indicate who.

Would you like to:

If Other, please specify:

Interests

Are you interested in membership for a spouse and/or dependent children (ages 15-18)? *

What fitness areas are you most interested in (check all that apply)?

Group Exercise

Walking/Running

Aquatics/Pool

Basketball

Racquetball/Squash

Cardiovascular Training/Equipment

Strength Training/Equipment

Day Spa

Other

If Other, please specify:

How would you like us to contact you?