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To Sign-Up for the LIFELINE Healthy Weight Program

Thank you for your interest in our Healthy Weight Program, we are very excited about this opportunity to work together. You have already made the hardest step--deciding that you want to change your lifestyle to become healthier, feel better, and look the way you want to look.

The registration process is quick and easy. Simply fill in the information requested below and click SUBMIT at the bottom of the page. Reservations are taken on a first-come, first-served basis. The five week program meets from Noon to 12:30 pm on consecutive Tuesdays. The program is open to the first 100 registrants. When we receive your registration we will e-mail you the information on which class you are enrolled in, how to obtain the class materials, and the telephone number to call.

First name:
Primary e-mail address:
Age:
Gender:
Height:
Weight:
Please answer the three questions below using a scale from 1 to 5 with 1 signifying Never, and 5 signifying Always. Record your answer in the box to the right of the question. In the past month, how often did you find yourself overeating? In the past month, how often did you skip planned exercise? In the past month, how often did you feel badly about yourself?

Requirements For Participating

Due to expected popularity of this program and limited class enrollment, we ask all interested employees to commit to four important requirements in order to participate:

Attend all 5 teleclass sessions. Classes are delivered via the telephone during the Noon to12:30 pm lunch time for 5 consecutive Tuesdays.
The only cost for participating will be any long distance fees to connect with the teleclass or coach.
Request permission from your supervisor to participate if you will be at work.
Complete several short class assignments.
Provide a post personal assessment and evaluation of the program upon completion.

If you agree to these requirements and have completed the requested information click SUBMIT below to register.

If you have any problems with the registration process, please call us at 816-753-8283.

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