WI StrongBodies Leader Sign Up 2018


In order to be inclusive, we will be slowly moving from the term StrongWomen to StrongBodies. Same Fabulous Training!!
Registration Fee: $250 includes training, manual, lunch, breaks and promotional materials and exercises for your own StrongBodies programs. Payable by check to Rock County UW-Extension 51 South Main St. Janesville, WI 53545.

Enrollment is limited. Please register early to ensure your place.

Registration Deadline is one month prior to the training date.

Questions? contact Angela Flickinger WI StrongWomen Ambassador
angela.flickinger@ces.uwex.edu
608-757-5689

First Name *
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Last Name *
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Home Address Street Name *
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Home Address City *
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Home Address: State *
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Home Address Zip *
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Work Address Street Name *
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Work Address City *
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Work Address State *
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Work Address Zip *
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Phone number (home/cell) *
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Phone number (work) *
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Email address (home) *
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Email address (work) *
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Tshirt Size (Womens) *
Employment/Volunteer Organization *
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Job Title *
Your answer
The organization that I represent and that I intend to use the StrongBodies Program in is: *
Location Where You'll Be Implementing StrongWomen *
Include City/Town, County & State
Your answer
Your background & experience related to health and physical activity *
Your answer
Do you have a CPR certification?
It is highly recommended to be CPR certified to teach StrongWomen. Some counties may require leaders to have their certification. Check with your coordinator.
Confirmation Statement 1: I regularly lift weights/strength train *
Confirmation Statement 2: I fully understand that after this training, I will be trained to teach participants in my community in the StrongBodies program but NOT to train new trainers to teach the program *
Confirmation Statement 3: I fully understand that this program in ONLY to be offered in nonprofit settings/organizations *
Gender
Race/Ethnicity
check all that apply
Which StrongWomen workshop are you attending? *
Are you an Extension educator? *
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