January Eat Healthy Registration - Wellness

Name*

First Last

Employee / Student ID*

Email (This will be used to send weekly messages)*

Phone (This will be used to contact you if you are a prize winner)*

How did you hear about the Try It Challenge? (check all that apply)*

Email
Word of Mouth
Print
Social Media (Facebook, Twitter..)
Other

If a co-worker encouraged you to sign-up, enter their name and they will get entered into a drawing for encouraging wellness!

Weekly emails will be sent with updated results to keep all participants motivated. And results from the challenge will be posted to the Ship Shape Wellness website. Please indicate yes or no about sharing your name and “new” activities.*

Yes, you may share my name and answers
No, do not share my name and answers

Phone

This field is for validation purposes and should be left unchanged.

Maine Maritime Academy

A COLLEGE OF ENGINEERING, MANAGEMENT, SCIENCE, AND TRANSPORTATION

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January Eat Healthy Registration Form