CommunityFit Registration

Name

*First name

*Last name

Age

*Email

Address

Street

City

State

Zip

*Employer Type

Employer Name

Pre-Survey

Are you currently a Western Health Advantage Member?

How many minutes of moderate physical activity do you get in a typical week?

Do you currently engage in mindfulness-based practice?

What do you hope to gain from participating in WHA's CommunityFIT program?

*By checking this box, I agree to the terms and conditions set forth in the CommunityFIT liability waiver

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