McLean S&H Pilot Registration

Registration Form
POWER BRAINing - Pilot Program

at McLean sport&health

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DUE TO OVERWHELMING DEMAND

The POWER BRAINing Pilot Program IS FULL

HOWEVER, STARTING SOON, WE WILL BE ALLOWING A LIMITED NUMBER OF PEOPLE TO PARTICIPATE IN THE PILOT PROGRAM'S POWER BRAINing CLASSES, FOR FREE. To get on the wait list for free POWER BRAINing classes, simply fill out the form below.

POWER BRAINing Pilot Program - CLASS DETAILS:
- Class Location: Regency sport&health (1800 Old Meadow Rd McLean VA (Note: You do not need to be a S&H member to take these POWER BRAINing classes)
- Class Time: Noon to 12:50pm
- Class Days: Mondays, Wednesdays & Fridays
- Start & End Dates: Starts Wed, Oct 25 and ends Wed, Dec 13, 2017 (NO classes on Nov 22 or Nov 24)
- What To Wear: Soft sole shoes and comfortable work out clothing
Questions? Contact Mike Harrigan at 703-930-0400 or email at BrainingCenter@headstrong1.com.
POWER BRAINing - Pilot Program

at McLean sport&health

Congratulations! By filling out this brief Registration Form you reserve your spot as a "Participant" in The Braining Center's FREE "Pilot Program" - granting you FREE POWER BRAINing classes. Here's what that means:
- you receive FREE access to all POWER BRAINing Classes, throughout the Pilot Program period
- Pilot Program Details:
  - Class Location: McLean sport&health - 1800 Old Meadow Rd McLean VA (you do not need to be a S&H member to take these POWER BRAINing classes)
  - Class Time: Noon to 12:50pm
  - Class Days: Mondays, Wednesdays & Fridays
  - Start & End Dates: Starts Wed, Oct 25 and ends Wed, Dec 13, 2017
- you will try to attend at least 2 classes per week (unless you have unavoidable conflict)
- you agree to provide feedback about the classes (brief survey at the end of each class)
- these classes includes physical exercises, much like other physical fitness classes, and you affirm that you do not have any medical conditions which would make taking such a class inadvisable
You will receive a confirmation email within 24 hours after submitting this form. If you do not receive a confirmation, or if you have any questions, contact Mike Harrigan at 703-930-0400 or email at BrainingCenter@headstrong1.com.
Name*

First NameLast Name
Email*
example@example.com
Best Phone Number*

Area CodePhone Number
Are you a member of Sport & Health?*

YesNo
How did you hear about this program?*

S&H NewsletterS&H Open HouseTennis emailZone4 emailFriendBraining Ctr emailOther
What is your age range?*

Under 40 Yr Old60-69 Yr Old40-49 Yr Old70-79 Yr Old50-59 Yr Old80+ Yr Old
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any medical condition which might prevent you from taking a fitness class, or make taking such a class inadvisable?*

YesNo
Will you do your best to commit attend 2 to 3 POWER BRAINing classes per week during the Pilot Period (barring unforeseen conflicts)?

YesNo
Will you provide honest feedback about the POWER BRAINing classes, including taking a short 1-min survey after each class?

YesNo
The Braining Center is also offering FREE neuro-cognitive evaluations to a select few of the Pilot Program Participants. If you are chosen to take part in the free Evaluation Program, you will receive a comprehensive pre-evaluation, the week before the classes begin, as well as a comprehensive re-evaluation the week after classes conclude. Each evaluation will take about 30 to 60 minutes, and would normally cost over $400. Are you interested in participating in the FREE Evaluation Program?

YesNo
Have a question or comment? Type it here.
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Registration Form