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Fifth Dimension Health & Fitness Club, Ebley Wharf Mill, Stroud - Tel: 01453 769120

PERSONAL DETAILS

Name:
Title:
Date of Birth:
Home Address:
Postcode:
Email Address:
Daytime Tel:
Evening Tel:
Mobile Tel:
Best time to contact:
How would you prefer to be contacted:

FRIENDS DETAILS
Friends name:
Friends Address:

How did you hear about The Fifth Dimension?
Word of Mouth
Stroud News and Journal
Corporate mailout
Internet
Other:

REGISTRATION

A member of the team will contact you to confirm your trial 3 day membership.



Simply fill out this form and dont forget to add a friends details and you will be eligible for a 3 day trial pass. If your already a member why not nominate 2 friends who for a trial and if they join you will recieve a free gift!