Fitness Online Panel – Payment Details

Thank you for showing your interest in taking part in the Fitness Online Community research.

Your payment will be sent via cheque quarterly (every 3 months) which will be posted to you, please note that this process can take up to two weeks from when we have confirmation of your participation during each 3 month period.

Please fill in your details below and make sure all are correct and up to date. If your address changes, please contact us via email or phone to let us know.

None of this information is ever passed onto any third parties and will be stored securely

Many thanks,

The Members Team

Your Contact Details

Your Contact Details

First Name *

*THIS IS HOW WE HAVE YOUR NAME WRITTEN ON OUR DATABASE*

Surname *

*THIS IS HOW WE HAVE YOUR NAME WRITTEN ON OUR DATABASE*

Daytime Contact Telephone Number *

*THIS IS THE DAYTIME CONTACT NUMBER WE HAVE FOR YOU - PLEASE CHECK THIS IS CORRECT*

Alternative Contact Telephone Number

Email Address *

*THIS IS THE EMAIL ADDRESS WE HAVE FOR YOU - PLEASE CHECK THIS IS CORRECT*

Your Cheque Details

Please write your FULL NAME as you'd like it to appear on the cheque *

Please fill out the FIRST LINE of the address to send the cheque to *

Please fill out the SECOND LINE of the address AND TOWN/ CITY to send the cheque to

County * AberdeenshireAngleseyAngusAntrimArgyll (Argyllshire)ArmaghAyrshireBanffshireBedfordshireBerkshireBerwickshireBrecknockshireBuckinghamshireButeshireCaernarfonshireCaithnessCambridgeshireCardiganshireCarmarthenshireCheshireClackmannanshireCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDownDumbartonshireDumfriesshireDurhamEast LothianEssexFermanaghFifeFlintshireGlamorganGloucestershireGreater LondonHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonderryLondonMerionethshireMiddlesexMidlothianMonmouthshireMontgomeryshireMorayshireNairnshireNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshireRadnorshireRenfrewshireRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandTyroneWarwickshireWest LothianWestmorlandWigtownshireWiltshireWorcestershireYorkshireOther

Postcode *

*THIS IS THE POSTCODE WE HAVE FOR YOU - PLEASE CHECK THIS IS CORRECT*

Please let us know of any other information we need to know before posting your payment

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