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Rock CF Kicks Back
Whether you’re on your tenth half marathon or just getting started jogging to the mailbox, we want to get you in a new pair of kicks. This program is currently only open to US residents. Apply below!
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth (Please note, this program is open for people with CF who are 6 years old or older)
*
MM
/
DD
/
YYYY
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone number
*
Your answer
Email
*
Your answer
Age
*
Your answer
Gender
*
Male
Female
Prefer not to say
CF Care Center
*
Your answer
CF Physician
*
Your answer
What are your current exercise habits?
*
Your answer
Do you have any exercise goals?
*
Your answer
Are you currently on a modulator?
*
Yes
No
Prefer not to say
Would you be interested in providing a picture of you (or your child with CF and you) for the Rock CF Foundation's website and social media outlets? (Please note: only first name will be used)
*
Yes
No
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