2022 Winter Challenge Enrolment form

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Fill out the form below to get started and help us on our mission to Walk the length of NZ.

Email address *

First & last name *

Address *

Phone number *

What is your WHY? Why are you signing up?

What is currently stopping you from achieving your goals?

Legal stuff - By Signing up to this challenge you agree to the following: *

That participating in this program is entirely at my own risk.

That I have my doctors permission to participate in this exercise program or that I have decided to participate without my doctors permission.

Acknowledge that participation in exercise activities carries with it potential hazard. You therefore release Empower Me Fitness & Consulting directors, volunteers, trainers and licensees and sponsors of any liability resulting from injury or death during the challenge or its related activities

Required

How did you hear about the challenge?

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