Send for your complimentary one-day pass entitling you to full use of the Central YMCA facility!

We'd really like to hear from you. Just fill out this short form and and click SUBMIT FORM. We'll reserve for you a complimentary one-day pass for full use of the Central YMCA facility. If you'd like us to send you additional membership information, just indicate that in the COMMENTS section below.


 



Name:
eMail:
Phone:



 



Do you currently belong to a gym or to an athletic club?

 		Yes
No
If YES, how many times per week do you usually attend?
every day
5 - 6 times
3 - 4 times
1 - 2 times
less than once/week
rarely or never


 



Where did you first hear about the Central YMCA?

Which of the following Central YMCA activities/ facilities are of primary interest to you? (Check all that apply)
Life Circuit machines
Stairmasters / Treadmills
Free Weights
Swimming
Basketball
Racquetball
Youth programs
Senior programs
Aerobics
Cycle Reebok
Cybex
Personal Training
Indoor Track
Massage / Sauna
Volunteer programs


 


(We welcome any questions or comments you may have)