Get Up & Go Activity Completion Form
To be completed after your group or organization has completed it’s health & fitness activity.

Please fill out the information below so that we can get a final update about your group’s activity.  We want to use the information to award recognition certificates and get a final update of the campaign’s overall success for a celebration event that we are planning in May.

All other information will be kept confidential and used for contact purposes only.*
Name of Organization or Group:

City of Location:

Number of people participating:

Contact Name:

Telephone:

E-mail:

Please confirm your e-mail:

Health & Fitness Activity:

Age Group: (Hold the ctrl key to make multiple selections)

 

Comments:


 

*  After the campaign period (April 1 through April 30, 2008) we would like to tally a report on the total number of groups and participants involved (i.e. 200 organizations and 6,000 individuals participated overall).  In order to accomplish this task, we will need to ask each participating group to give us an estimated count of those in their organization who participated.  Any results of individual groups or organizations submitted through this form will remain confidential and will not be publicly reported.


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