Registration

Fields marked with * are required.

First Name *
Last Name *
Address *
City *
County *
State *
Zip *
Phone *	- -
Please enter a unique username for your forum account.
UserName *
Please enter a password for your user account.
Password *
Confirm Password *
Please enter a valid email address for yourself.
Email Address *
Confirm Email *
*
Please type in verification code
Activity Survey
How much time do you spend walking daily? *
Do you prefer to: *
Do you walk: *
How much time do you spend working out or otherwise being physically active? *
How active is your spouse? *
How active is your child? *
When was the last time you were on a bike? *
Would you be interested in learning how to shape up your skills on a bike? *
Would you be interested in joining a bike/walk to school or work group? *
If you have children, do they have bikes? *
If you have children, do they have helmets? *
How many adults in the household have a bike? *
If zero, would they ride a bike if they had one? *
What is the total number of bikes in the household? *
Do you think the street you live on is safe to ride a bike? *
Name of your street: *
Does your street have sidewalks? *
Would you be interested in volunteering with Activate? *
Thank you for taking time to complete this survey. Your input matters!

September 1, 2008

September 1, 2008

September 2, 2008

15 minute group walk for those beginning their journey to active lifestyles.