Medical Endorsement of Exercise & Lifestyle Management Authorization Form
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By submitting this form you consent to  have your name added to the list of signators to the Medical Endorsement of Exercise and Lifestyle. Physicians, medical professionals, and individuals with a PhD in public health or related fields are eligible to sign this letter. A copy of the document can be viewed at:
Full Name *
Organization *
State *
Credentials (e.g. MD, MPH, PhD, etc) *
Preferred email *
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