Name of Club ____________________________ Date ________________
Name of Club Contact ___________________________________________
Name of Business ___________________ Type of Business _____________
Name of Manager ___________________ Owner _____________________
Business Location ___________________ Telephone # ________________
Employee free membership awarded to ______________________________
for as long as the box in placed in the above location.
Employee group rate sheets wanted? NO __ YES __ If YES, date of sheet drop off ________________
Flyers, coupons to distribute to members? NO __ YES __ If YES, date of pick up? ________________
PARTICIPATION IN SEMINARS? NO __ YES __ If YES, date of seminar _______________________
I AGREE TO THE BENEFITS PROVIDED BY THE CLUB AND WILL DO MY PART TO HELP THEM PROMOTE THEIR CLUBS IN MY BUSINESS. I AGREE TO CALL THEM IF THERE ARE ANY PROBLEMS WITH THEIR BOX.
Owner/Manager _____________________________ Date ______________
2nd week follow – up
Dropped of membership card for employee? Received by ________________
Chose free 6 month membership winner? Chosen by ___________________
CLUB USE ONLY
Date contacted 6 month winner? ____________________ By ____________
Date of picture to be taken? ________________________ Date sent to paper _________________
