Member Profile Form

As a new member of the Evolutis Family, we have each of our clients complete their "Member Profile."

We ask all of our clients to complete this so we can get to know you a little better and to make sure we're doing everything we can to help you reach your goals!

It will take about 2-3 minutes to complete.

Please answer the questions below!

* Indicates required field

1. What is your full name? *

2. What is your mobile number? *

3. What is your email address? *

4. What is your date of birth? (DD/MM/YYYY) *

5. What is your address? (In case we want to send you something!) *

6. Marital Status? *

Single Engaged Married

7. Do you have children? *

Yes No

8. If you answered yes, what are their names and how old are they? *

9. What is your occupation? *

10. What is your employers name? *

11. Would your work or office be interested in Evolutis delivering a lunch & learn or workshop? *

Yes No Maybe

12. What are your hobbies? Do/did you play any sports? *

13. Are you or have you been a member of any other gyms or clubs? *

14. Do you have pets? What are their names? *

15. What are you favourite Facebook pages or websites? *

16. Favourite radio station? *

17. Favourite TV show? *

18. Favourite local restaurant? *

19. Favourite local shop? *

I agree to receiving marketing and promotional materials

Submit

Member Profile Form

Please answer the questions below!

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