Personal Training Requests If you are interested in working with a personal trainer, please fill out the request form below. Personal Training Request Form Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*My YMCA Branch:*SelectC.W. Avery Family YMCA - PlainfieldGalowich Family YMCA - JolietMorris Hospital YMCA - MorrisMy Training Level:*SelectBeginnerIntermediateAdvancedPhysical Restrictions or Medical Complications:Goals and Objectives:*Exercise history (last six months):*Specific times available for training:*Specific trainer preference, if any:EmailThis field is for validation purposes and should be left unchanged.
