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Email/Username*
Password*
Re Type Password*
First Name*
Last Name*
Date of Birth*
(dd/mm/yyyy)
Gender*
Workplace Role
Daytime Phone Number*
Hours Worked per Week
Marital Status
How did you find out about Active Steps? Other :

Company Reference Code

(Company registrations will require a code, please contact your HR manager or program manager for further information)

Delivery details (Please note this is where your pedometer unit and information will be sent)
Title
Street Address*
Suburb*
State*
Post code*
Is this a business or residential address? Business   Residential

Business Name:

 
Note:

1. Please note an email will be sent to the email address for the account validation. So please enter a valid email address.

2. The cost per participant is $49.95 & p&h. An electronic tax invoice will be sent once you have registered. Your account will be immediately activated and pedometer and sponsor gifts sent once payment has been received in full. Please allow 48-72 hours for delivery once payment has been received