Personal activity plan

Complete this form to register for your personalised activity plan

*Indicates required

Your details

Title*
First name*
Surname*
Gender*

If you provide us with your email address, it means we can send you advice and offers to help you and your family live a healthy and active life.

Email*
Email address confirmation*
Your mobile

Create your account password

You’ll need a password to access your personalised activity plan when it’s ready.

Password*

Your address

Postcode*
Address line 1*
Address line 2
Town*
County

2nd Adult's name

Want a personal action plan for your partner or another adult? Just fill in the sections below.

First name

Surname

Gender

Please help us by telling us what prompted you to sign up for Get Going (tick all that apply):

Leisure / Sport Centre Event
Local Event
Change4Life Roadshow
Change4Life Website
Change4Life Email
Other

In future, are you happy for us to send you more great Change4Life stuff (tick all that apply)?

Email
Post
SMS
Telephone
All Of The Above