Healthy Butler

Healthy Butler Registration

Username and Password
*Username:
*Password:
Name and Contact Information
*First Name:
*Last Name:
*Street Address:
Address (cont'd):
*City:
*State:
*Zip Code:
Phone Number:
*Email:
*Re-enter Email:
Program Information

The information contained in this section is used only for calculations shown on your personal Progress Page to help you track and obtain your goals. Some information may be used for anonymous statistics with the Healthy Butler program.

*Birthday: Date format MM/DD/YYYY
*Gender:  Female       Male
*Height:  Feet     Inches
*Current Weight:  Pounds
*Weight Goal:  Pounds
*Activity Goal:  Minutes per Week
Optional Information
Are you registered for a special program?:
Are you a member of a team?:
Current Activity Habits:
Motivation Level (to reach goals):  1=Low 10=High
Why did you join Healthy Butler? (check all that apply): Improve my physical health
Feel better about myself
Improve my appearance
Win a prize
Motivation for regular exercise
Motivation to increase activity
Family or friends encouraged me
Promotional message motivated me
Reverse diagnosis of disease
How did you hear about Healthy Butler?:
Who referred you to Healthy Butler?:
Would you like to receive our weekly enewsletter?:
I prefer to receive emails in HTML format:
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