Register Your Club with Project VisAbility

Club Name *
Street
City
State
Zip
Country *
Phone
Website
Contact Name
Contact Position
Contact Number
Contact E-mail
Is club individual?     or part of chain? 
How many clubs are in your chain?  
Do you currently have the Johnny G Krankcyle® by Matrix at your club? (check if yes)
If no, are you willing to purchase at least one? (check if yes)
Do you have members with disabilities who currently use your facility? (check if yes)
Do you have members with disabilities who participate in group exercise? (check if yes)
Have you ever hired a group exercise instructor with a disability? (check if yes)
     If yes, please explain
     
What kind of specialty does your club have?
     Kranking Spinning/Cycling
     Fusion Personal Training
     Boot Camp Other
If your club has another type of specialty, please explain
Do you have any additional information you'd like us to know about?
By typing your name in the field below, you agree that all the information in this form is
correct and you are authorized to apply to become a Project VisAbility Club Member.
I agree (type name)    Date
   

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