Register

Registration Form

Lady Light! We are so excited that you are taking your first step to Ignite Your Health. After completion of your registration you will be directed to the get to know you questionnaire so we can understand you and your health and fitness goals better. Let’s get started by filling out the registration form below. Bismillah!

First Name *

Last Name *

Gender *

Female

Male

NOTE: This is a women's only health and fitness service.

Date of Birth *

Email *

Phone *

How would you prefer us to contact you? *

Phone

Text

Your Area *

Emergency Contact Name *

Emergency Contact Number *

Username *

Password *

Please include an upper case letter, a symbol, a digit and a minimum length of 8 characters in your password.

Confirm Password *

By proceeding with this registration form, you are agreeing to the terms set out within the Lantern Life Fitness code of ethics. *

I agree

Register

Register

Registration Form

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