Membership Information Request

724.225.WELL

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NAME:

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ADDRESS:

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OCCUPATION:

How did you hear about the Wilfred R. Cameron Wellness Center? (Please consider

family/friends, newspaper ad, another member, web site, mail, Washington Hospital, etc.)

EVENING PHONE:

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Did your physician refer you?

Have you ever belonged to a fitness center before?

If yes, how long?

Would you like to receive mailings from Spa Harmony at the Wellness Center?

Would you like to receive email notices on programs & services?

Comments:

Copyright © 2008 W.R. Cameron Wellness Center

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Mrs

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