RECLAIM Application Form
Join us for the full RECLAIM program, starting August 14, 2018!
1. Full Name *
Your answer
2. Email address *
Your answer
3. Telephone number *
Your answer
4. What is your biggest challenge when it comes to sticking with your healthy diet? *
Your answer
5. This group will include information, strategies, tips and exercises plus a good degree of personal sharing among members. Are you willing to share openly and honestly with others in the group? *
Your answer
6. The meetings will take place on Tuesday evenings at 8:00 PM EST, twice per month from August 2018 to January 2019. Are you able to commit to at least 80% of these meetings? *
7. Why do you think RECLAIM might be a good program for you? *
Your answer
8. Is there anything else I should know?
Your answer
Thank you! I will be in touch shortly with more details.
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