Request an appointment

Please select the centre nearest you, complete the form below and a membership consultant will contact you shortly to confirm your appointment. Please allow for a minimum of 1 working days notice.

All fields marked with an * are compulsory

Your Details
Title:	Please select Mr Mrs Miss Ms Dr Prof
*First name:
*Surname:
*Home Phone:
Mobile Phone:
*Email:
*Goals:	Please select Lose weight / Fat Loss Lose weight / Gain Muscle Improve strength Improve endurance Improve overall fitness Tone & Shape Other
*How did you hear about ECU Sport & Fitness Centre:	Please select Newspaper ads in the Wanneroo Times Newspaper ads in the Joondalup Times Newspaper ads in the Eastern Suburbs Poster / flyer I received ECU Campus TV Monitors Inside ECU Poster / Flyer at our sports centre Web search Other
*Nearest Centre :	Please select Building 22, Joondalup Campus WA Building 21, Mount Lawley Campus WA
Preferred Date:	Select date
Preferred Time:	Please select 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm 1:30 pm 2:00 pm 2:30 pm 3:00 pm 3:30 pm 4:00 pm 4:30 pm 5:00 pm 5:30 pm 6:00 pm 6:30 pm
General Comments: