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Request Information For additional details on GlobalFit and how your fitness club can benefit from being a GlobalFit provider, please complete this form. A GlobalFit representative will contact you as soon as possible. Your Club Name: Owner's Name: Manager's Name: Phone: Fax: Your Email Address: Type of Club: <Choose one> . Fitness Only . Multi-purpose . All Women Number of Clubs: Total Square Feet: Club Website: Club Address (Line 1): Club Address (Line 2): City: State: <Choose one> Alberta Alaska Alabama Arkansas Arizona British Columbia California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska New Hampshire New Jersey Newfoundland/Labrador New Mexico Nova Scotia Northwest Territory Nunavut Territory Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island South Carolina South Dakota Saskatchewan Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Yukon Territory Not Available Zip Code: Comments:

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