Basic Details
In this form we collect some basic details to enroll you for a Mental Fitness Club Membership. Please fill in the details carefully.
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Email *
Name *
Phone Number *
Address *
What is your profession? *
Which of the following explains your financial position best? *
Please indicate what is your financial position below. (1=Very Poor, 2=Poor, 3=Middle Class, 4=Rich, 5=Very Rich). We use this to determine eligibility for our community support services.
Very Poor
Very Rich
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