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
Copyright © 1999-2004 by OK Initiatives, Inc.
All Rights Reserved
|
