Member Application

Before completing your application, we require that all prospective members read through our Prospective Members Information Package. By submitting this application you are confirming that you've read and fully understood the information package.

Please complete the application form below. If you have any questions, feel free to contact us at info@prescriptiontogetactive.com.


* Required Field

Member Information
Numbers only (i.e. 7805551234)
Numbers only (i.e. 123)
Application Questionnaire