The Mastermoves
100 Days Challenge

REGISTRATION FORM


Firts Name:___________________________ Last Name:_____________________________

Birth Date:______________ Gender:_______________ Current Weight:______________

Address:__________________________________________________City________________

State/Prov.:_______________________________________________ZIP/Postal____________

Home Phone:_______________________ Work Phone:_____________________

Email Address:______________________________________________________

Registration fee: $US 20 or $CAN 30

Method of Payment
 Visa  Master Card  Check  Cash  Money Order

Credit Card Number:______________________________ Expire Date: ________________

Full Name on Card: ________________________________Signature: __________________

Please register by:

  • Faxing this REGISTRATION FORM to (604) 642-6231
  • Phoning (604) 642-6241
  • Mailing this REGISTRATION FORM and CHECK to:

OK Initiatives, Inc.
1315 Broughton St., Suite 205
Vancouver, B.C.
V6G 2B6, Canada

 

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All Rights Reserved