The Healthy Muslims Program - Application Form
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Name: *
Email: *
What is your age? *
What is your gender? *
Country and city: *
Why do you want to join The Healthy Muslims Program? *
What is your main goal you would like to achieve over the next 3 months? *
What is one thing you will do when you achieve your health goals? *
In order to finally make a change, you have to invest both time and money. There are limited 1 on 1 spots to help you achieve your goals. Are you ready to financially invest in yourself? *
Do you have coverage to see a Registered Dietitian through your extended health insurance? If yes, please indicate how much below for the year. If no, leave the space below blank.
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