Online Form - 6 Week Challenge Registration Form

Main Opening Hours Table
Monday	5:30am-8:00pm
Tuesday	5:30am-8:00pm
Wednesday	5:30am-8:00pm
Thursday	5:30am-8:00pm
Friday	5:30am-8:00pm
Saturday	7.45am – 11.00am
Sunday	Closed

Full Name *

Date of Birth *

Are you a current member?

YesNo

Membership # (if known)

Display Name *

Do your contact details need updating on our system?

YesNo

Phone number

Email address

Address

Street Address:

City:

State:

Post Code:

Country:

Would you like to be added to our challenge chat?

YesNo

Would you like more information on our Personal Training Special Offer? *

YesNo

How did you hear about our challenge? *

In-centre AdvertisingWord of MouthSocial MediaWebsiteEmailOther

I give give permission for ERC staff to photograph me. I understand the photo/s may be used for promotional purposes (including online and social media) and on marketing material that may be distributed to the general public.? *

YesNo

I give give permission for ERC to publish my Name/Display name and my body composition results (% lost/gained only). I understand my results may be used for promotional purposes (including online and social media) and on marketing material that may be distributed to the general public.. *

YesNo

Is there any further info you would like to provide?