Burbage Slimming World Registration Form

Burbage Slimming World

Slimming World Registration Form
Come along and join us...

You are more than welcome to just turn up on the day and fill in your details when you arrive.

To save time, you can pre-fill your joining form below — it’s quick and easy! (Payment is taken at your first group meeting.)

You Are Joining the..

Mondays at 6 p.m.

📍 Burbage Millennium Hall,

Britannia Rd,

Burbage, Hinckley.

LE10 2HF
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*

Confirmation Emailre-enter your email (they must match)
Birth Date*

DayMonthYear
Date
Address*

House No. or Name and Street Address

Street Address Line 2

City/TownCounty

Postcode
Your Height*
Gender*

FemaleMaleOther
Have you followed the Slimming World plan before?*

YesNo
You are joining*
We currently only have this one group available
Oops! This form is for the Burbage Slimming World Group only.

🕕 Group time: Mondays at 6:00 p.m.
📍 Location: Burbage Millennium Hall
Britannia Road, Burbage, Hinckley
LE10 2HF

If you’re trying to register for a different Slimming World group, get in touch with the Consultant for that group directly and please do not submit this form.

✅ Still want to join our friendly Burbage group?
Please re-select:
“Burbage Slimming World Group – Monday 6:00 p.m.”

from the dropdown menu above.

We can’t wait to welcome you!
We’d love to know how you found out about Burbage Slimming World — your answer helps us spread the word and is truly appreciated! (Tick more than one if applicable)

Burbage SlW Group WebsiteMet the ConsultantMessage from ConsultantBanner or Poster outside the venueTwitterLetter from ConsultantSlimming World WebsiteFacebook Post about this groupAdvert in Local MagazineGP SurgerySlimming World AppLeaflet through my doorSearched online, GoogleLocal Newspaper AdvertRecommended by a friendNational AdvertPoster with group detailsArticle in Local Newspaper/MagazineReader offer in Newspaper/Magazine
Anything else you wish to tell your consultant? (Specific targets you are working towards?)
Before you click Submit

We would like to say a big thank you and welcome.

This is your first step in completing the registration form in advance of your first visit. Your welcome pack is waiting for you along with a warm welcome from Terry, Natalie and the rest of the Burbage Slimming World Group.

You will be required to pay your joining fee and your weekly group fee. You may also take advantage of our discounted block bookings for 6 or 12 weeks.

*If you are over 60, a discount will apply to the fees.
We will let you know the cost and take payment on your first visit. But you can use the below to know what you will pay. (you can cahnge your mind on the day)

Joining FeeOver 60 one week feeOne week FeeOver 60 - 6 weeksBlock Book - 6 WeeksOver 60 - 12 weeksBlock Book - 12 weeks
Calculation
Here is your cost based on your selection above. We will let you know the actual cost and take payment on your first visit. (you can cahnge your mind on the day)
Should be Empty: