Five Miles Further: Discovery Survey

1

Where are you located (county / region)?* This field is required.

2

What is your level of physical fitness?* This field is required.

Sedentary

Brisk walk 3-5 times per week

Weekly strength training

Weekly cardio and strengthening activities

I am a performance athlete

5

What types of programs or events interest you?* This field is required.

Decompression Days (Community Hikes: Around 3 miles / 2-3 hours)

Discovery Days (Workshops, usually outside or on a short walk)

Destination Days (Destination Focused Hikes: Around 4-5 miles)

Basecamps (1-2 night camping trips with education sessions and hikes)

“Five Miles Further” Days (Small group events that are highly adventurous)

6

Do you have any barriers or limitations that might affect your participation in outdoor activities?Consider recent or existing injuries, or medical concerns (i.e.: diabetes, heart conditions, epilepsy, asthma, serious allergies, etc.)

YESNO

7

If yes, please specify:

8

Do you experience any anxieties or fears related to outdoor activities?

YESNO

9

If yes, please specify.

10

How to stay in touch? (Check both, if applicable)

A Facebook group (please visit / join http://tinyurl.com/fivemilesFB for updates)

Email (please provide below)

11

Name

First Name

Last Name

12

Please share your email address

example@example.com

13

Phone Number (Optional)

Please enter a valid phone number.