MBI Interest Form
Want to stay active and healthy with the Move Better Initiative? Fill out this quick form and we'll be in touch about programs and events near you.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Zip Code
Preferred Method of Contact
Phone
Email
Text
Consent to be Contacted
Yes
No
Age Range
18-20
21-25
26-34
35-44
45-54
55+
Race
Black/ African American
White
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
Other
Initiative of Interest
Adults-Only Field Day
Senior Fitness
Nutrition Education
10K Step Challenge
Other
Other Interests
Desired Involvement
Participant
Volunteer
Donor
Partner
Just want to be informed
Current Activity Level
Not active
Somewhat active
Active
Very active
Accessibility Needs or Accommodations You May Need?
Anything else you'd like us to know?
Consent to Be Contacted
*
Submit
Should be Empty: