Registration

Your login name will automatically be created as the first initial of your first name plus your last name plus the last 4 digits of your phone number. 

For example: Jenny Smith's phone number is 867-5309.  Her login name would be jsmith5309. 

If Jenny's siblings John, Jane or Jack Smith had already created user jsmith5309 then she would have seen a message that says "The username is already in use. "  If your username has already been taken, try using a different combination such as a nickname, middlename or a different number.

First Name:
Last Name:
Last 4 digits of phone number:
Last 4 digits of SSN or other # (to be used as password):
Email:
retype Email:
Gender:	femalemale
Age Group:	< 1818-29 30-3940-4950-59> 60
Ethnicity:	African AmericanAsianCaucasianHispanicNative AmericanOther
Address Line 1:
Address Line 2 (if applicable):
City:
State:	SCNCGAOther
Zip
Phone:
Height	(feet)    (inches)
Group/Company (optional):	(optional) Richmond County (please check to see if your group, business, or corporation is participating)
In addition to joining Activate South Carolina, you also have the opportunity to take part in a project to determine Activate South Carolina’s impact on body mass index and physical activity participation. Taking part in this project simply allows anonymous use of the information you enter on the Activate South Carolina website. There are no known risks for taking part in this study. Your participation is completely voluntary and in no way impacts your participation in Activate South Carolina. You have the right to withdraw from the study at any time without penalty. If you have any questions about this study, you may contact Dr. Alicia Powers of the Health and Exercise Science Department at Furman University (E-mail: alicia.powers@furman.edu; Phone: 864-294-3224). We are eager to have everyone participate in this project; however, if you do not wish to participate, please indicate below. I do want to participate in the project described above. I do not want to participate in the project described above, but understand I can still participate in Activate South Carolina.
In submitting my entry, I for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have now or hereafter arising against the YMCA of Greenville, Greenville Hospital System, and Furman University, other YMCAs of South Carolina, North Carolina, and Georgia, and all sponsors and their employees, officers, directors, principals, agents, representatives, successors, and assigns, including but not limited to any and all claims of damages, injuries, demands, actions whatsoever, however they may occur, arising as a result of my participation directly or indirectly in said YMCA of Greenville programs. Furthermore, I hereby grant full permission to any and all of the foregoing to use my name, my voice, and/or picture in any broadcasts, telecasts, advertising, promotion or other account of this event for any purposes whatsoever without thought of remuneration. If under 18, parent’s signature required.   I agree to the terms specified in the waiver