Register

Please fill in the following information to create a user account for this website.

Full name

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E-mail

Your details

Postcode

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Telephone

Gender

Age

Ethnicity

Your lifestyle

Do you have a longstanding illness or disability?

Have you taken part in any sport or active recreation in the last four weeks?

How many days per week do you undertake a total of at least 30 minutes of moderate intensity physical activity?

(an activity that leaves you feeling warm and slightly out of breath)

In the last twelve months, how much time, on average, each week have you volunteered in Sport or Physical Activity

How important do you feel sport and active recreation is in improving quality of life in your local area?

Would you be interested in taking part in taster sessions or receiving information on: (please tick as many that apply to you)

Health Walks	Dance
Keep-fit	Gym / Workouts
Badminton	Swimming
Tennis	Running / Jogging
Cricket	Rugby
Football	Netball
Hockey	Table Tennis
Cycling	Archery
Rowing	Gymnastics / Cheerleading / Trampolining
Athletics	Other

For monitoring and evaluation purposes only, we would like to track your levels of activity with a short follow-up electronic questionnaire. If you do not want to be contacted then please tick the box

This information may be used by Northamptonshire Sport and partners. If you do not want to be contacted, receive information about future sport and leisure events or have your information shared, please tick the box