New Member Sign Up Form

Thank you for your interest in signing up with Ogie Shaw Fitness.

Membership in the Ogie Shaw Fitness On-Line Testing Service is for anyone wishing to be more successful at becoming and staying physically fit . It provides: health screening, fitness self-testing instructions, personal on-line fitness testing file, assignment to a personal fitness counselor, email or phone counseling for all forms of exercise, "How do I measure up?" comparisons of your scores to others in your profession, age geographical location, and my quarterly newsletter. There is a small monthly fee for these services. The equipment and instructions for testing are already in your Isorobic Exerciser kit. If you do not own the Isorobic Exerciser or did not purchase it through Ogie Shaw Fitness you may order the fitness test kit by clicking on the Products tab. For prices for the on-line testing membership services click on the Testing Services tab.

To Get Started please be sure to complete all the requested information where there is a red asterisk (*) next to the field title.

New Member Application
*Required Fields  
*Office Location: WEB: Internet Sign Up
Other Occupation:
*First Name:
*Last Name:
*Postal/Zip Code:
Work Phone:
*User Name:
Leave Password blank unless you want to change your Password.
*Password Confirm:
Consider Strong Passwords Using Mixed Case & Numbers. We suggest: q4092e3A
To use this randomly generated password
Be sure to write down your password in a safe and secure location.
*Birth Date: (i.e. 04/23/1988)
*Send Newsletter:
(please type the number between the brackets into the verify field above): [543267]
Health History Questionnaire
DO YOU NOW HAVE, OR HAVE YOU EVER HAD:(Check all that apply)
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Acknowledgement of Risk
I accept the Acknowledgement of Risk: