Weight Watchers Pre-Registration Printout, Page 1: Member File Copy
(Bring BOTH this printout and Confirmation printout to your first meeting) Weight Watchers Pre-Registration Printout, Page 2: Confirmation
(Bring BOTH this printout and Member File Copy printout to your first meeting)
Sequence#:
(for back office use)
Last name:
First name:
Address:
Address Cont.:
City:
State/Province:

Please Check if You:
Do not wish to receive coupons or offers by postal mail
Do not wish to receive correspondence in the mail from your meeting room staff
Do not wish to participate in telephone surveys

Email address: (Include ONLY if you wish to receive special offers and information via email)

Phone:  Work Home Cell

Date of Birth (MM/DD/YY) Age (For calculating daily PointsPlus® target)
Female / /
Male
Receptionist instructions:
At Paper Tally locations:
1. Receive both Pre-Registration printout pages from the joining member.*
2. Take a blank Registration Card from your location’s supply. Fill in the member name ONLY at the top.   Write its Registration number on
    both printout pages where indicated.
3. Complete the Staff Only section on the Confirmation printout. Have the member sign and date the Release on  the Confirmation printout (page 2).
4. Place the bar code sticker from the Registration Card on the joining member’s Weight Record. Proceed with Enrollment as usual.
5. Separate the Registration Form and give the member the back pages.
6. Staple the Confirmation printout (page 2) to the top Registration sheet and send in the Tally envelope.
7. Place the Registration Card/Progress Card in a member file folder. Fold this printout (page 1) and store it inside the folder. Use its information
    for member contact as warranted. Include this printout when processing completion.

At CHAMP locations:
1. Receive both Pre-Registration printout pages from the joining member.* Scan the Pre-Registration # on this  page (below). The Personal Info
    screen will display on CHAMP with pre-populated info.
2. Scan a blank Registration Card from your location’s supply. CHAMP will add this number to the Personal Info screen. Click Continue.
3. Proceed with Enrollment as usual. Place the bar code sticker from the blank Registration Card on the joining  member’s Weight Record.
4. Have the member sign the Release on the Confirmation printout (page 2).
5. If purchasing a Monthly Pass, have the member fill in and sign the Monthly Pass Purchase and Activation section of the blank Registration Card.
6.  Separate the Registration Card. Give the member the bottom pages, plus this printout (page1). [
Note: in champ locations members are
    supposed to get the second page of the reg form in addition to pages 1-7 (the back pages)
]
7. Attach printout page 2 to the top Registration sheet and place in the Weekly Mailer.

* If only one printout page is presented, use normal Enrollment procedures.
Pre-registration#
If unable to scan this bar code, use CHAMP Member Search box to find info: Set Search for Pre-Registration ID. Enter the Sequence # shown above the member name. Click Search. Note: If online pre-registration was completed today, no records will be available in the system yet.
STAFF ONLY

Registration#
Weight Watchers Pre-Registration Printout, Page 1: Member File Copy
(Bring BOTH this printout and Confirmation printout to your first meeting) Weight Watchers Pre-Registration Printout, Page 2: Confirmation
(Bring BOTH this printout and Member File Copy printout to your first meeting)
Sequence#:
(for back office use)
Last name:
First name:
Address:
Address Cont.:
City:
State/Province:

Please Check if You:
Do not wish to receive coupons or offers by postal mail
Do not wish to receive correspondence in the mail from your meeting room staff
Do not wish to participate in telephone surveys

Email address: (Include ONLY if you wish to receive special offers and information via email)

Phone:  Work Home Cell

Date of Birth (MM/DD/YY) Age (For calculating daily PointsPlus® target)
Female / /
Male

If you require any accommodations for a disability in order to avail yourself of Weight Watchers services,
please specify:


RELEASE
I want to become a member of Weight Watchers. I will in no way hold Weight Watchers responsible for any physical or mental condition that might occur because of my Weight Watchers membership.  I have read and agree to abide by the Health Notice and Terms of Membership.

I understand that Weight Watchers gladly accepts my check as payment and, in the unlikely event that these funds are dishonored, Weight Watchers has the right to collect them electronically for the face value plus processing fee.

I acknowledge receipt of the Membership Information materials and have read or will read the Maintenance Information notice included therein.
Today's Date (MM/DD/YY)
Release Signature:_______________________________________ / /

     
Area #
STAFF ONLY

Registration#
         
Location #
     
.
 
Start Weight
 
 
 
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