BEXS/MCEP - Revitalize Program

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* 1. Your details:

Name

Email Address

Phone Number

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* 2. Please indicate whether you are staff or a student at Flinders University:

Staff

Student

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* 3. Do you currently exercise for more than 150 minutes per week?

Yes

No

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* 4. Do you participate in resistance/strength based training?

Yes

No

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* 5. Do you currently have any injuries that prevent you from exercise?

Yes

No

Other (please specify)

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* 6. Please indicate your session preferences:

Monday 07.00 - 08.00

Monday 12.00 - 13.00

Monday 17.30 - 18.30

Tuesday 07.00 - 08.00

Tuesday 12.00 - 13.00

Tuesday 17.30 - 18.30

Wednesday 07.00 - 08.00

Wednesday 12.00 - 13.00

Wednesday 17.30 - 18.30

Friday 07.00 - 08.00

Friday 12.00 - 13.00