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Your Name:
What is your phone number? Please list 2 if possible:
What is your complete address? :
What is your email address?:
How did you hear about The Mommy Movement?: Craigslist.com Facebook Flyer Google Street Sign Web Search Word of mouth
What do you wish to attain by joining The Mommy Movement?: Bond with my baby Build muscle tone Have more energy Learn healthy habits Lose weight Maintain healthy lifestyle Meet other moms Model a healthy lifestyle for your family
How often do you exercise?: 2 times a week 3 times a week 4 times a week 5 times a week or more Once a week Rarely, but would like to start
Which package are you signing up for?: A. 1 Class B. 5 class package C. 10 class package (attend once a week) D. 10 class package E. 20 class package F. 30 class package G. Unlimited Monthly Pass
Have you been referred by a TMM Member? if so please list her name:
Which classes are you most likely to attend?: Saturday Morning Class @ 9am Thursday Morning Class @ 9am Tuesday Morning Class @ 9am
Please write the date of the first class you plan to attend. :
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