1.  Have you ever participated in a regular exercise program? Yes No
2.  Have you gained weight since you began driving a truck for a living? Yes No
3.  If you answered yes how much weight did you gain?
4.  How many years have you been driving?
5.  Would your quality of life be improved through regular exercise? Yes No
6.  Would your self-esteem be improved through regular exercise? Yes No
7.  Do you believe regular exercise can improve your mental health? Yes No
8.  Would you exercise regularly if it were convenient to do so? Yes No
9.  Do you think you have time to exercise 20 minutes per day? Yes No
10.  If your company shared the expense, would you invest in and use
       an exercise system to improve your health? Yes No

Reason you purchased a Gym today

Reason you did not purchase a Gym today

Do you think you will buy a Gym at a later date? Yes No

Please provide the following contact information:

Name	Phone
Street	Cell
City	E-mail
State/Province	Zip/Postal Code
Company Name	Company Phone
Company State
*Random drawings will take place of all entries on the last day of March, June, September and December.  Winner will be notified immediately via phone and email to make arrangements for prize collection. Winners will also be listed below. Once you have registered your name will be in all future drawings. Winners will be pulled from the pool of participants. Prize must be claimed within 30 days of notification. If  you purchased a gym in the previous 3 months and you win, you will receive a complete refund. Purchases must be verifiable through company records.