ONLINE REGISTRATION FORM

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Last Name		First Name		Initial A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Male Female
St. Address		City	State Zip Country
Home Phone		Office Phone		Ext #
Pager / cell		In the rare event of emergency WSF should contact your		<< Select >> Spouse Immediate Family Relative Doctor Friend
Email		Telephone		Contact person
Occupation / School		Last School
Height ft	in Weight lbs Birthdate month day year
Please identify the course, program or seminar/work shop(s) you are interested in signing up for or attending
Release conscent
************ PLEASE READ ************ In consideration of being accepted as a student of the World Sports Fitness Inc. -and for - Other good and valuable considerations, the receipt and sufficiency whereof being acknowledged, I, my executor, administrator or assign herewith forever release and discharge said World Sports Fitness Inc., Pierre F. Mouele, all of their owners, agents, servants and employees, fellow students, instructors and affiliated organizations will not be responsible for any liabilities by reason of any type of injury I may sustain during instruction, practice, exhibitions, demonstrations or otherwise on or off location. I, the applicant, personally assume all risks of hurt or injury and agree that I enter and participate in activities within and regarding World Sports Fitness Inc. at my own risk.
	I have read, understood and agree to the terms of the Release conscent: yes or no
Do you have any special health needs
Additional comments