Running Program Interest Form

Name:
Address:
City:
State:
Zip:
Phone:
Email Address:
Birthdate:
Interest:
 Walking
 Running
Running Experience:
 Beginner - Never done a race or it's been awhile
 INTERMEDIATE - Occasional runner - can do a 5k but it doesn't feel great
 ADVANCED - Can do a 5k want to challenge myself and improve time
What is your 2017 goal?
What kind of support are you looking for?
 Motivation  Training Program  Social  Technique  Other
 
If you selected other please explain:
When times are you interested in meeting for a group run?
 5-7AM  7-9AM  9-10AM  12-1PM  5-7PM
 
What days are you interested in meeting for a group run?
 Sunday  Monday  Tuesday  Wednesday  Thursday  Friday  Saturday
 
Please share any past injuries or health concerns you may have (this is confidential):