GO Active Participant Registration Form

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* 1. Are you new to Silver Joggers

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* 2. What is your Name?

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* 3. Are you...

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* 4. How old are you?

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* 5. What is your postcode?

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* 6. What is your email address?

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* 7. What is your telephone number?

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* 8. What is your ethnicity?

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* 9. In the past week, on how many days have you done a total of 30 minutes or more of physical activity which was enough to raise your breathing rate and break out in a sweat? (This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job)

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* 10. Do you have a long term illness, health problem or impairment that limits your daily activities?

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