Kick The Diet - Keeping on Track

Submitted by Ali T on Wed, 12/05/2010 - 09:40

For those participants who wish to continue to continue to progress the success of the 8 week programme

Registration

contact

Name: *

Please enter your name or user name if you are a registered user

Address: *

Your postal address.

Contact No: *

Your prefered contact telephone number

E-mail Address: *

Your preferred contact email address

What method do you prefer to be contacted : *

Personal

Occupation: *

What is your job

Date of Birth: *

Smoker: *

Acitivty Levels

What is your current weekly activity ? :

What, activities have you tried in the past?:

Why did you stop?:

Do those factors still apply?:

What have you done, until now to control your weight?:

Aspirations

What do you hope to achieve from following the kick the diet programme? (3 answers): *

How would it be if you didn’t achieve this? (What is the problem with your current shape and size?): *

How would it be if you did achieve this? (How will your life be better?): *

Additional comments :

event: *