Personal DetailsName* First Last Email* Confirm Email* Telephone*Address Address Town/City Postcode County Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands DOB MM slash DD slash YYYY Your Course or ClassWhat is your overall fitness goal? Which of Our Fitness Offerings would you like to sign up to?Body SMART CourseUltimate Personal Training ToolkitPrivate ClassKickboxing & Interval Training (8am Saturdays)Padbox & Core (9am Saturdays)Pi-barre (10am Saturdays)Course required (Body SMART only) Monday's and Wednesday's 6.30pm - 7.30pm Monday's and Wednesday's 7.30pm - 8.30pm Tuesday's and Thursday's 6.30am - 7.30am Please note that our courses fill up very quickly as we only allow max 5 per course. Where we always try our best to accommodate your preferred slots please note that this isn't always possible. We shall contact you to confirm that your chosen days and times are available. Forms and MedicalPlease tell us about any previous injuries or medical conditions that might affect you during exercise. Medical Questionnaire Completed I have completed my medical questionnaireStudio safety sheet I Agree I have read and understood the Studio Safety SheetPhotography/video/audio release I Agree I have read and understood the Photography/video/audio release form Deposit PaymentHow would you like to pay your course fee? (You will receive our bank details or you can come into the studio to pay by cash before your start date.)Bank TransferCashNext of Kin DetailsName PhoneTerms and ConditionsTerms and Conditions* I Agree I have read the Terms and ConditionsPrivacy Statement I Agree I have read the Privacy StatementHere at iOme Fitness we take your privacy very seriously and will only use your personal information to administer your account and to provide the products and services you have requested from us. However from time to time we would like to contact you with details of other offers and services we provide as well as recent news or updates about iOme Fitness. If you consent to us contacting you for this purpose please tick to say how you would like us to contact you. Email Telephone Post Text Q's and A'sDo you have any other questions ? EmailThis field is for validation purposes and should be left unchanged.