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Full name: *
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Name you preferred to be called:
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If minor, name of parent or guardian:
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Email: *
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Confirm Email*
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Date of Birth: *
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MM/DD/YY
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Sex:
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M/F
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Address: *
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Address 2:
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Zip Code: *
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City: *
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State: *
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Cell/Mobile/Best phone number *
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Alternate phone number (please specify if this is home, business, etc.)
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Please specify if this is home, business, etc.
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Emergency Contact:
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Name, Relation to you
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Emergency Contact Phone Number:
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Physical Limitations (if applicable):
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How did you hear about Team Move?
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Please let us know who we can thank - a current client (please specify name), newspaper, TV/News airing, magazine, google, etc. Mahalo!
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Program you are registering for *
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Please select the program you are registering for.
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Please contact me with any specials that Team Move will be offering.
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Yes
No
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By electronicially signing this form, I will in no way hold any member of "Team Move, LLC" responsible for any injury whatsoever. I understand
this that is a voluntary workout/fitness program and I enter upon my own will, understanding the risks involved. If you have any physical limitations, or before starting any exercise program,
we advise you to check with your physician. Also, by electronically signing this form, I hereby grant Team Move, LLC., and any of its partnering subsidiaries, permission to record,
photograph, and resuse for their commercial and/or promotional benefit, my likeness or personage in any reasonable fashion without expectation of any compensation. If under 18, you are
signing this on behalf of your child if you are the child's legal parent/guardian. *
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Yes - Electronic Signature Valid upon clicking this button
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