AWreg

"ACTIVE WOMEN" REGISTRATION

* Indicates required field

Participant Full Name *

First

Last

Select Program Name (if a former g.a.b member) *

Approximate year you attended. *

How did you hear about Active Women? *

D.O.B (yyyy/mm/dd) *

Height (in ft.) *

T-shirt size *

Phone Number *

Email *

Instagram handle *

City *

Province *

Postal Code *

EMERGENCY INFORMATION:

Emergency Contact Name *

First

Last

State relationship *

Phone Number *

Please specify any medical conditions: *

PAYMENT INFORMATION:

Please bring exact cash when you are dropping in. $5 g.a.b member. $10 non-g.a.b member.

SUBMIT