Language
English (US)
Spanish (Latin America)
Walking Group Registration Form
Discover the numerous benefits of walking and meet new people in a fun, friendly environment! We will confirm you registration and answer any questions within three business days.
Fridays @1:00pm
Meet in front of the Boys and Girls Club, 4619 Jenewein Road, Fitchburg 53711.
Walker Name
Name
First Name
Last Name
Email
example@example.com
Phone Number
Birth Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Best method of contacting you.
Telephone
Text
Email
Emergency Contact
First Name
Last Name
Emergency Phone number
Please enter a valid phone number.
Do you have any medical conditions that we should know about?
Diabetes
Asthma
Allergies
Chronic Obstructive Pumonary Disease
Cancer
Arthritis or joint problems
High Blood Pressure
Other
Other
Longest distance that you can walk without resting?
1 neighborhood block
3 neighborhood blocks
.5 mile
1 mile
no rest required
How frequently do you plan to walk?
weekly
bi-weekly
monthly
when I am able
What is your reason for walking?
Any questions?
Submit Form
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