Fields with asterisks (*) are required.
First name
*
Last name
*
Email
*
Home phone
*
Business phone
Cell phone
I am a Wayne State University student who is currently enrolled.
Yes
No
I am a Wayne State employee currently enrolled in the Wellness Warrior program and would like to utilize my personal training benefits provided by the employee wellness program.
Yes
No
I have already completed a fitness assessment with the Mort Harris RFC and would like to schedule my personal training sessions. (Please note, if you have not completed a fitness assessment your first PT session could take up to 1 ½ hrs.)
Yes
No
Trainer preference
*
Male
Female
No preference
Is there a specific trainer you'd like to work with?
Number of training sessions per week
*
Availability: (A day of rest in between weight training sessions is strongly recommended)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred training time
*
6-8 a.m.
8-10 a.m.
10 a.m.-noon
noon-2 p.m.
2-4 p.m.
4-6 p.m.
6-8 p.m.
8-10 p.m.
Areas of Interest
*
Strength training
Stretching
General health
Cardio training
Weight management
Body building
Injury rehab
Other