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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Status at MC

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* 4. Please enter your MC email address below. 

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* 5. Please enter your phone number below.  

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* 6. On average, how many days per week do you engage in moderate
to strenuous exercise (like a brisk walk)?

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* 7. On average, how many minutes do you engage in exercise at this level?

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* 8. Takoma Park/SS Campus Only 
Are you available for Personal Training on Mondays and Wednesdays from 11:00 am - 12:15 pm starting on Sept. 21?

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* 9. Rockville Campus Only 
Are you available for Personal Training on Mondays and Wednesdays from 2:00 pm - 3:00pm?

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* 10. Student Trainer Preference

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* 11. Please indicate your health and fitness goals.

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* 12. Please describe any exercise limitations. 

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* 13. How did you hear about the opportunity for Personal Training sessions? 

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