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Confidential <br />EXHIBIT A -1 <br />FACILITY INFORMATION <br />The information in the box below is intended for marketing purposes. Please confirm that it is accurate. <br />Facility Name: <br />Physical Address: <br />Phone Number: <br />Web Site Address: <br />*To enable marketing of amenities and services are marketed, please designate your basic amenities below and all <br />amenities upon initial lop in to the Fitness Provider Portal• <br />Amenity /Program <br />X❑ <br />Offered as part of basic <br />membership at no additional cost <br />to Members <br />Cardiovascular Equipment <br />Group Exercise /Aerobics Area <br />Hot Tub/Whirlpool <br />Resistance Training Equipment <br />Steam and /or Sauna <br />Swimming Pool — Seasonal (not available throughout the year) <br />Swimming Pool — Year -Round <br />Fax: <br />General Email: <br />Direct Fax O Need to call first <br />Who will be our Primary location contact (Healthways Program Advisor)? This individual will be responsible for <br />scheduline trainine, coordinadw with our Provider Service Liaison and will need access to member records <br />Contact Person: <br />Contact Title: <br />Contact Phone: <br />Contact Fax: <br />Contact Email: <br />