Get Up & Go Partner Form
 Thank you for considering your role as a possible partner in the St. Clair County "Get Up & Go" campaign and website.  In the space below, please tell us about your organization and your particular area of interest.

We would like to list your group or organization as a participating member.  All other information will be kept confidential and used for contact purposes only.*

Name of Organization or Group:

City of Location:


Contact Name:

Telephone:

E-mail:

Please confirm your e-mail:

Website Address: (If you would like to include a link)

Please Check All That Apply:

We're interested in promoting some of our organization's Health and Fitness events through this Website.
We're interested in becoming a participant on the Get Up and Go Planning Team.
We're interested in becoming a member of the Website Review and Development Team.
We're interested in becoming a member of the Ask the Experts Team
We're interested in making a donation to the Scrivner, MD Public Health Foundation to develop and maintain the Get Up and Go Campaign.



Please tell us how you found our website:


Comments/Questions:


 

*  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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With Special Thanks
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Upcoming Events
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Thanks to Our Partners