Home » Feetbeat 2010 » Feetbeat Online Enrolment

Please fill out the entry form below and then click on the "Submit" button. Alternatively, you can download a printable version of the enrolment form and post or fax your entry. Entries are to be received by 10 September 2010.

We will respond to any information requests as soon as possible.

Team Information

All information collected for FeetBeat will remain confidential

Workplace name *

Workplace address

Team name *

Team leader name *   

Team leader email *

Team leader phone 

Number in team4 5678

* Required fields marked with an asterisk. Please fill out one line below for each member of your team. Don't forget to put your details in as well.

	First Name	Surname	Email	Gender	Ethnicity	Age Range
1				FM	-Select- Maori Pakeha/NZ European Pacific Island Asian Other	-Select-< 1515-34 35-5455+
2				FM	-Select- Maori Pakeha/NZ European Pacific Island Asian Other	-Select-< 1515-34 35-5455+
3				FM	-Select- Maori Pakeha/NZ European Pacific Island Asian Other	-Select-< 1515-34 35-5455+
4				FM	-Select- Maori Pakeha/NZ European Pacific Island Asian Other	-Select-< 1515-34 35-5455+
5				FM	-Select- Maori Pakeha/NZ European Pacific Island Asian Other	-Select-< 1515-34 35-5455+
6				FM	-Select- Maori Pakeha/NZ European Pacific Island Asian Other	-Select-< 1515-34 35-5455+
7				FM	-Select- Maori Pakeha/NZ European Pacific Island Asian Other	-Select-< 1515-34 35-5455+
8				FM	-Select- Maori Pakeha/NZ European Pacific Island Asian Other	-Select-< 1515-34 35-5455+

Remember: Any activity that is part of your job cannot be counted as part of your Feetbeat activity

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