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* 1. Last Name

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* 2. First Name

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* 3. Date of Birth (Used as secondary identifier)

Date / Time

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* 4. E-mail (Enter This Carefully/Correctly as this is where your confirmation e-mail will be sent)

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* 5. How many minutes a week do you think you can commit to "Sworkit"?  Remember this is about increasing your current activity level with exercise you can do ANYWHERE.  We suggest 30-45 minutes, but you are your own expert. 

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