Please supply your personal information
For family comcession, Please provide the main family member's Weigh-Less Member no.
Date Of Birth
Postal Address (If different to home address)
Number of Dependants
How did you hear about Weigh-Less :
Is this the first time you are joining Weigh-Less
If no, how many times?
Full Time Student
Medical Aid Scheme
Medical Aid No.
In order to be better understand your current lifestyle. Including health and dietary-related concerns as well as your personal perceptions about health eating, and what you may expect from your diet, please answer the following questions as truthfully