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Registration Form
Please fill out the form with your information to register.
* Required Data
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Name
*
Phone
*
Email
Policy Number
NRC Number
Channel Name
Bancassurance
Agency
Face to Face
Operation
JP Corporate
Local Corporate
Other
Please select the club you want to register for
*
Running Club
Yoga Club
Zumba Club
Please select the date to attend for Running Club
*
September 13 (Saturday) 6:30 AM - 9:00 AM
October 11 (Saturday) 6:30 AM - 9:00 AM
November 15 (Saturday) 6:30 AM - 9:00 AM
Please select the date to attend for Yoga Club
*
August 3 (Sunday) 9:30 AM - 10:30 AM
August 10 (Sunday) 9:30 AM - 10:30 AM
August 17 (Sunday) 9:30 AM - 10:30 AM
August 24 (Sunday) 9:30 AM - 10:30 AM
August 31 (Sunday) 9:30 AM - 10:30 AM
Please select the date to attend for Zumba Club
*
August 2 (Saturday) 9:30 AM - 10:30 AM
August 9 (Saturday) 9:30 AM - 10:30 AM
August 16 (Saturday) 9:30 AM - 10:30 AM
August 23 (Saturday) 9:30 AM - 10:30 AM
August 30 (Saturday) 9:30 AM - 10:30 AM
Gender
*
Male
Female
How did you hear about this event?
*
Friend or colleague
Facebook
Website
SMS
Other
Participants consent to the use of their images and activity photos on GGI Nippon Life’s social media.
*
Yes
I hereby acknowledge that in the event of an accident or any health-related incident of me, I accept full responsibility and assume all associated risks.
*
Yes
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