Membership Packages One Time Enrollment Fee $150.00

Transcription

1 Membership Packages One Time Enrollment Fee $ Conrad Classic $85/month Conrad Classic membership provides unlimited, 24-hour access to facilities including fitness center, locker rooms, steam room, and saunas. Membership also provides access to Infinity Edge swimming pool seven days a week from 6 am 10 pm. Complimentary Polar Body Age Assessment and complimentary valet parking included. Classic Members also receive: 15% off Conrad Indianapolis accommodations 50% off Fitness Beverages and Snacks Conrad Premier $180/month Conrad Classic membership provides unlimited, 24-hour access to facilities including fitness center, locker rooms, steam room, and saunas. Membership also provides access to Infinity Edge swimming pool seven days a week from 6 am 10 pm. Complimentary Polar Body Age Assessment and complimentary valet parking included. Premier Members also receive: Two Complimentary Personal Training Sessions One complimentary Day Guest Pass per month 15% off Conrad Indianapolis accommodations 25% off additional Personal Training sessions 50% off Fitness Beverages and Snacks Conrad Platinum $275/month Conrad Classic membership provides unlimited, 24-hour access to facilities including fitness center, locker rooms, steam room, and saunas. Membership also provides access to Infinity Edge swimming pool seven days a week from 6 am 10 pm. Complimentary Polar Body Age Assessment and complimentary valet parking included. Platinum Membership also receives: Four Complimentary Personal Training Sessions Two complimentary Day Guest Passes per month Complimentary Shoe Shine during workout Laundry Pressing Services available 15% off Conrad Indianapolis accommodations 45% off additional Personal Training Sessions 50% off Fitness Beverages and Snacks Spouse Add-Ons Ons: $65/month

2 New Member Benefits In appreciation of choosing Conrad Fitness, all new members will receive: $25 Conrad Gift Certificate One one-time complimentary Personal Training session Personal Training Packages Individual One Hour Personal Training Session $75/hr 12 One Hour Individual Personal Training Sessions (Total $840) $70/hr 24 One Hour Individual Personal Training Sessions (Total $1584) $66/hr

3 Membership Application Thank you for choosing Conrad Fitness. Please print your information below. Membership Type: Salutation: First Name: Last Name: Residence Address: City/State: Zip: Residence Phone: Address: (to be used by Conrad Fitness only) Name of Employer: Position: Business Address: City/State: Zip: Business Phone: Spouse s Name: Child s Name(s): Did someone refer you to Conrad Fitness? If yes, who? Preferred Method of Communication: Home Phone: Business Phone: Check here to receive Conrad Fitness member updates and promotional news. Personal Information Driver s License No.: Date of Birth: SSN: Family Physician: Phone: Signature: Date:

4 P.T. Client Medical and Exercise History Client Name: Age: (If above the age of 70,, additional screening must be completed) Sex: M F Phone No.: : Medical History Do you have and medical conditions that could be acerbated by physical activity? If so, please explain: Are you pregnant? Y N If so, how many weeks? Have you had any past surgeries? If so, when and what type? Have you had any injuries? Were you diagnosed by a physician? If so, what was the diagnosis? Have you undergone Physical Therapy/Rehab for this each injury? Y N What activities aggravate? Are you cleared for full activity without restriction? Y N If not, any specific guidelines from your physician/therapist? Emergency Contact and phone #: Client Cleared To T Exercise: e: Y N (If no, client will need Doctor approval)

5 Exercise Readiness Questionnaire (ERQ) Name Date DOB Age Home Phone Work Phone Regular exercise is associated with many health benefits. Increasing physical activity is safe for most people. However, some individuals should check with a physician before they become more physically active. Completion of this questionnaire is a first step when planning to increase the amount of physical activity in your life. Please read each question carefully and answer every question honestly: Yes No 1) Has a physician ever diagnosed you with a heart condition and indicated you should restrict your physical activity? Yes No 2) When you perform physical activity, do you feel pain in your chest? Yes No 3) When you were not engaging in physical activity, have you experienced chest pain in the past month? Yes No 4) Do you ever faint or get dizzy and lose your balance? Yes Yes No No 5) Do you have an injury or orthopedic condition (such as a back, hip, or knee problem) that may worsen due to a change in your physical activity? 6) Do you have high blood pressure or a heart condition in which a physician is currently prescribing a medication? Yes No 7) Are you pregnant? Yes No 8) Do you have insulin dependent diabetes? Yes No 9) Are you 69 years of age or older and not used to being very active? Yes No 10) Do you know of any other reason you should not exercise or increase your physical activity? If you answered yes to any of the above questions, talk with your doctor before you become more physically active. Tell your doctor your plan to exercise and to which questions you answer yes. If you honestly answered no to all questions you can be reasonably certain you can safely increase your level of physical activity gradually. If your health changes so you then answer yes to any of the above questions, seek guidance from a physician. Participant signature Date

6 Credit Card Payment Authorization Form Please complete all areas below. Incomplete requests may be rejected. This form must be received at least 5 business days prior to the Check-In, or by specified date in Event Contract, to ensure acceptance of the credit card to be charged. Do not send completed form by . FAX COMPLETED FORM TO: ATTN: HOTEL USE ONLY: Date: Authorized Amount: Approval Code: Date: CARDHOLDER - Please complete the following section and sign/date below. Guest / Group Name: Check-In / Event Date: Name of Fitness Member: Phone: Cardholder Name as it Appears on Credit Card: Cardholder Billing Address: City: State: Zip: Daytime /Business Telephone: Evening Telephone: Credit Card Number: Expiration Date: Credit Card Type: (Circle one) Visa/MasterCard American Express Discover JCB Diners Club Credit Card Issuing Bank Name: Bank Phone Number (from back of your credit card): I agree to cover the following categories of charges: (Please circle) All Charges Membership Fees Enrollment Fees Personal Training Sessions I agree to cover the above categories of charges up to a Maximum Amount of $ Note: Charges for monthly membership fees will automatically be charged to your account on the 15 th of each month. Additional fitness services including personal training sessions, as well as, initial Enrollment Fees will be charged to your account immediately. Amount to be immediately charged to credit card for room and taxes or deposit: $ Final Balance Billed to Credit Card (hotel use only): $ By signing below, you authorize the hotel to charge your credit card immediately for the amount indicated above up to the Maximum Amount indicated above. You further acknowledge that if all charges has been selected, then all guest/group related charges (less Deposit) will be charged to the above card number at the time of check-out or event conclusion. Cardholder Signature: Date: Rev 04/10

7 1

8 2

9 3

10 4

11 5

12 6

13 7