Please complete this form for EACH fitness business location and provide the below required documentation to validate your eligibility for the Health & Wellness Enhancement Grant.

Required documents:

PDF of a redacted 2023 tax form 1065 or 1120 or Schedule C of 1040 showing IRS documentation of club revenue.
PDF of a current W-9 Form from the IRS that provides your correct Employer Identification Number (EIN) (New applicants only)
PDF of a redacted lease agreement to verify a brick and mortar fitness establishment (New applicants only)

Submission deadline is February 28, 2025

Next Steps Information:

Michigan Fitness Association will review the information you provided for EACH fitness business location. Upon validation, you will be required to sign a grant agreement. This agreement will be shared with the Owner via email in April 2025. Once MFA receives your signed Grant Agreement, grant checks will be mailed beginning in June 2025.

Did you receive a round one Health and Wellness Enhancement Grant Check from the Michigan Fitness Association in 2024? *

Yes

No

OWNER Information

Parent Company/Business Entity Name (if applicable)

Owner First Name *

Owner Last Name *

Owner Phone Number *

Owner Email *

Fitness Business Information

Separate form required for EACH fitness business location.

Fitness Business Name *

Fitness Business Address *

Fitness Business City *

Fitness Business State *

Fitness Business Zip Code *

Fitness Business Website *

What Wellness/Fitness Segment Describes This Fitness Business? *

Documentation

Upload a PDF of your current W-9 Form from the IRS that provides your correct Employer Identification Number (EIN) *

Upload a PDF or your redacted lease agreement to verify a brick and mortar fitness establishment *

Upload a PDF of a redacted 2023 tax form 1065 or 1120 or Schedule C of 1040 showing IRS documentation of club revenue. *

Grant Check Information

Grant Check Payable To: (checks cannot be payable to individuals) *

Grant Check Mailing Address *

Grant Check Mailing City *

Grant Check Mailing State *

Grant Check Mailing Zip Code *

Fitness Business Location Contacts

Michigan Fitness Association is excited to share information and resources with our members.

Please enter employees from this fitness business location that would like to receive items such as member updates, newsletters, invitations to conferences, webinars, and special events/promotions.

Fitness Business Location Contacts

	First Name	Last Name	Email	Job Title
Contact #1	First Name	Last Name	Email	Job Title
Contact #2	First Name	Last Name	Email	Job Title
Contact #3	First Name	Last Name	Email	Job Title
Contact #4	First Name	Last Name	Email	Job Title
Contact #5	First Name	Last Name	Email	Job Title
Contact #6	First Name	Last Name	Email	Job Title

Health & Fitness Club	Fitness Center	Personal Training
Cycling	Yoga	Circuit Training
Pilates	CrossFit	Other