Personal Training Request

Phone:

Binghamton Y, 607-772-0560 ext. 120

West Family Y, 607-770-9622 ext. 420

We look forward to helping you reach your health and wellness goals. Please complete the personal trainer request form. A personal trainer will contact you to set up your initial consultation. 

Name
Address
City
Email
Phone
Are you a Y member?
 Yes  No
 
Which YMCA branch do you prefer to workout at?
 Binghamton Y  West Family Y
 
What are your wellness goals?
Do you have a specific trainer in mind?
 Bob  Scott  Laura  Nancy  Jennifer  
Please list your preferred day(s) of the week to meet with your trainer.
 Monday  Tuesday  Wednesday
 Thursday  Friday  Saturday
 Sunday  
Please select the preferred time(s) you are available to meet with your trainer.
 6:00-9:00am  9:00am-12:00pm
 12:00-3:00pm  3:00-6:00pm
 6:00-9:00pm