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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 6 September 2013.

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

 

Team Information

All information collected for Feetbeat will remain confidential

* 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.

Team leader name *
Team leader phone *
  First Name Surname Email Gender Ethnicity Age Range
1
2
3
4


Remember: Any activity that is part of your job cannot be counted as part of your Feetbeat activity
© Copyright 2007 - 2011 Auckland Regional Public Health Service, ADHB. All rights reserved. Disclaimer

Private Bag 92 605 Symonds Street Auckland 1150
Phone 09 623 4600 Fax 09 630 7431
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