Name:
    Email:
    Address (where class will meet):
    Location Name:
    Name of room:
    Phone:
    Program Type: (Select All That Apply)

    If Fitness Class, preferred type(s):

    If Lunch and Learn, preferred topic(s):

    Preferred Day of Week:
    Preferred Start Time:
    Preferred Class Duration:
    Preferred Date(s):
    Floor surface (if fitness):
    Anticipated number of participants:
    Special Parking or Access:
    Sound System Available?
    Fitness Equipment Available?
    If yes, what equipment?
    If presentation, projector available?