FITNESS CLUB

Name: Age: Height: Gender: Weight:

1. Are you a current member a) Yes b) No 2. If yes, what type of membership do you have? a) Annual b) Monthly c) Quarterly 3. If no, have you ever been a member? a) Yes b) No 4. Why did you not renew your previous membership?

5.

Have you ever joined a health care before? a) b) Yes No

Thank you for your participation. Your input is greatly appreciated.

FITNESS CLUB
6. Please describe your lifestyle. a) Sedentary. I am glued to the computer screen most of the day b) Moderate. I do get occasional exercise c) Active. I exercise regularly 7. Which of these would best describe your diet? a) High calorie diet, starchy foods b) Moderate calorie but healthy fruits and vegetables c) Low calorie, healthy diet 8. Do you think there is adequate affordable access to fitness classes in Allahabad? a) Yes b) No 9. How important is exercise to your quality of life? a) Unimportant b) Somewhat important c) Important d) Very important 10. How often do you exercise? a) b) c) d) e) Never Rarely Weekly A couple of times a week Most days

11. Does a lack of transportation limit your access to fitness opportunities? a) Yes b) No

Thank you for your participation. Your input is greatly appreciated.

FITNESS CLUB

12. Would you exercise more if any of the following classes/activities were more available? (Select all that apply.)

Classes/Activities Yes Yes daytime evening Using exercise equipment (aerobic, strength training) Yoga Common interest groups (e.g. walking, hiking Dietician

Yes weekend

No

I do not know

13. Have you undergone surgery recently? a) Yes b) No 14. Additional questions or comments?

Thank you for your participation. Your input is greatly appreciated.