Name *

First Name

Last Name

Are you a Texins member? *

Yes

No

Building Name or Location *

Family Members & Retirees will select "Texins"

DMOS5

DMOS6

Kilby East

Kilby West

Research East

Research West

RFAB

SC Building

South Building

South Campus - Forest Lane

Texins - Family Memberships & Retirees

Choose one session to attend *

Tuesday & Thursday, 12-1pm

Wednesday & Friday, 3-4pm

Tell us the reason you have chosen to participate in Women of Weights? *

Select all that apply

To do something new

Improve my health

Learn how to safely lift weights

Learn how to create a workout routine

On a weekly basis which activities do you participate in? *

Select all that apply

Full body strength training at least twice a week

Accumulate 150 minutes of moderate aerobic activities

Not currently physically active

Other (Please Explain)

How confident are you using weight room equipment(i.e., machines, free weights, etc.)? *

Not confident at all

Somewhat confident

Very confident

Women on Weights is a paid program. Please select your payment method. *

NOTE: Your purchase is final and non-refundable. It is your responsibility to attend each session.

Payroll Deduction - REQUIRED for TI employees. I would like to pay for Women On Weights through a payroll deduction. By selecting this option you are authorizing Texins to proceed with a $70(TEXINS MEMBERS) or $80(NON-TEXINS MEMBERS) payroll deduction charge that will be submitted when this series begins.

Credit Card - REQUIRED for TI Family members, Contractors and Co-locaters. Please provide credit card payment at Texins Fitness Center front desk on or before the first session. If payment is not made on or before the due date then you will not be able to participate in this program.

Radio

Option 1

Option 2