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Registration



Branch Details
Country
State
City/Town
Payment Details
Payment Option
Membership Type
Monthly Amount
Personal Details
First Name
Last Name
Runner or Walker
Gender
Initials
Date of Birth
Email Address
Mobile Number
Address Line 1
Address Line 2
City
State
Zip Code
SSN (Last 4-Digits)
Sweatstep Profile Password
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Physical Details
Height (Inches)
Weight (Lbs)
Goal Weight (Lbs)
Emergency Contact Details
Contact Name
Contact Relationship
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Medical Questions
Please select your prior exercise duration/level category.
Do you have, or have you ever had, any of the following?
• Heart trouble, angina, a heart attack, heart murmur, or stroke? :
• Pain or pressure in the left or mid-chest area, left neck, shoulder or arm, particularly during or shortly after exercise? :
• Feeling of faintness, severe dizziness or excessive breathlessness after mild exertion? :
• Advice from your doctor that your blood pressure was too high or is not under control? :
• Advice from your doctor that your blood cholesterol level is/was elevated? :
• Diabetes? :
• Raised blood sugar? :
• A family history of coronary heart disease under age 55? :
• An abnormal resting electrocardiogram (ECG)? :
• Do you smoke? :
• Inactive lifestyle for 5 or more years AND aged 50 and over? :
• A medical condition not mentioned here which might need special attention in an exercise program, e.g.
Arthritis, Recurrent Backache, Asthma? :
• Do you presently take beta-blocker medication, e.g. one or more of the following: Betapressin, Blocadren, Cardispare,
Congard, Inderal, Inderetic, Lopsor, Pur-Bloka, Rexigen, Sectral, Sotacor, Sotazide, Tenoretic, Tenormin, Trasicor, Trasidrex,Visken. :

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