Strength Training Workouts That Work!       

Facility Licensing Information

Thank you for your interest in the Geri-FitŪ Program License. Please complete the online license application so that we are able to quote you accurately. If you are an Area Agency on Aging or County government that is applying for more than one location, please list all locations and their addresses in the Comments section at the bottom. Once your application is received, a Geri-Fit representative will contact you within 48 hours. This application is for quote purposes only and does not bind you to purchase anything.

Facility Information
Facility Name:
Address of Facility:
Your Name:

License Information
License will be purchased for:
Senior Center Recreation Center Area Agency on Aging
Retirement Community Health Club University/College
Non-Profit Dance / Yoga Studio County / City
Library Hospital Other
Number of Facilities that will offer Geri-FitŪ classes:
Are you working with a specific budget or grant funding amount?
Yes  No
If you answered Yes, what is the proposed budget?
When is your projected launch date to begin Geri-FitŪ classes?
Will you be the instructor?
Yes   No
Number of instructors that will need to be trained and certified in Geri-FitŪ:
Do you prefer training to be done online or delivered by a live Master Trainer-led one day workshop?
Online   Live Workshop
General Information
Does your facility currently offer any other evidence-based health promotion programs or chronic disease management courses?
Yes   No
If you answered yes, please provide the names of the programs that are currently offered at your facility:
How did you hear about Geri-FitŪ?
Did a sales rep or colleague refer you to Geri-FitŪ?
Yes   No
If yes, please state their name:
Comments or Questions:

Once you are through, enter the code to the right
so that your message can get routed to us.

By submitting this application, I hereby acknowledge the information in the application to be true and correct. I understand that this application is in no way binding to the applicant or GERI-FIT COMPANY LLC, and that this information will be used to assess the suitability and qualifications of the applicant or for quote purposes. I understand that any information I may receive from GERI-FIT COMPANY LLC is confidential and may not be used or shared without the consent of GERI-FIT COMPANY LLC.