Back Maintenance - World Gym BurpengaryDate* DD slash MM slash YYYY NAME OF PERSON COMPLETING THIS FORM* Person completing the Form* Staff Member Manager Contractor (Eg: Group Fitness Instructor) Personal Trainer Member Guests Phone Number* Location of Maintenance*Ground FloorMain FloorCardio - Main FloorLadies Zone - Main FloorCycle ZoneMain Studio - Group FitnessMind Body StudioFunctional ZoneWorld Gym Athletics ZoneMales BathroomLadies BathroomDisable BathroomSauna/Stream Room - Relaxation ZoneCafe (Including Kitchen)Reception (Including Supplement Shop)Kids World - CrecheOtherDescription of Maintenance Request*Enter Name* SignatureAll Comments will be treated with confidentiality and taken into consideration when planning changes to our Club. We appreciate your feedbackWorld Gym Burpengary | 159-161 Station Road, Burpengary Q 4505 | P 3053 3170 | E: reception@worldgymburpengary.com.au