Wufoo
2012 Trek Season Registration
COMMITMENT STATEMENT: "I will join thousands of women across the country in a walking challenge! My body is a blessing and I will do my best to take care of it. For 10 weeks, I will walk briskly for 5 days per week, for at least 30 minutes each day. I will talk about this pledge to as many women as possible to keep myself accountable and to further the mission of GirlTrek! Let's put the "move" back in movement!
TESTIMONY RELEASE: I understand and agree that the information and photographs submitted in this form may be used by GirlTrek to inspire others and further the mission.
Name
*
First
Last
Email
*
City, State
Tell us your story. Why are you joining this movement?
Describe your current level of activity:
I'm in shape. I work out 5 or more days per week.
I'm getting there. I work out a few days per week
I'm not in shape yet. I don't exercise very much.
How do you feel now?
Very happy
Somewhat happy
Not very happy
What is your age?
Cool Kid: 12 years old or younger
Teen: 13 to 18 years old
Young Adult: 19-29 years old
Adult: 30-64
Sizzling Senior: 65 years old or older
WHO IS YOUR REFEREE? Ok, who do you trust to call foul if you start to slip? Halfway through the season, we will email this person to ask "How's she doing? Is she still walking?" Who will tell us the truth? Hold you accountable? Keep you motivated?
First
Last
Referee's Email
SOLO or TEAM: How would you like to register?
*
A Solo Trekker: I will walk by myself this season
A Trek Team Member: I've been asked to join a team
A Trek Leader: I'm starting or continuing a trek team this season
[FOR TREK TEAM LEADERS ONLY] Describe your trek team. What is the name of your team. What city and state are you walking in? Who is on the team? Where will you walk? Every person will walk 5 days per week, but how often will the team walk together? Is this team dedicated to a cause or honoring a person?
[optional] SMILE! Upload a picture of yourself to share with our community. Pick your favorite picture. The pictures we feature most are website and FB page are action shots, big smiles and sunny outdoor pictures.
Do Not Fill This Out