Registration Form NAME * First Name Last Name EMAIL * PLEASE DESCRIBE YOUR LEVEL OF EXERCISE AND MOVEMENT DURING AN AVERAGE WEEK * ARE YOU PREGNANT? * YES NO IF YES, HOW FAR ALONG ARE YOU? DO YOU SUFFER FROM ARTHRITIS? YES NO DO YOU HAVE OSTEOPOROSIS? YES NO DO YOU HAVE SCOLIOSIS? YES NO LIST ANY INJURIES, ACCIDENTS, OR SURGERIES YOU HAVE HAD WITH APPROXIMATE DATES ARE YOU CURRENTLY YOU CURRENTLY UNDER A DOCTOR'S CARE FOR OTHER ISSUES? BRIEFLY DESCRIBE WHAT AREA OF YOUR BODY IS GIVING YOU THE MOST TROUBLE? ADDITIONAL COMMENTS YOU WANT TO SHARE? Thank you!
