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UMD Employee Wellness Program
Initiative Sign-up Form



Who are eligible: Faculty and Staff

Name
Department
Campus Address
Campus Phone #
Complete E-mail Address (_____@d.umn.edu)
Are you Faculty, P&A or Staff ? (click your selection)

As part of the UMD Employee Wellness Program Initiative , I would like to participate in (select one):

Option 1: 50-days of physical activity and healthy program--- click here to print log or for more info

Option 2: Attend 10 Health Improvement Program (HIP) meetings during Fall semester 2009 --- click her for more info and to register for meetings (registering will enable us to provide enough handouts)

Option 3: Attend 10 wellness workshops during Fall semester 2009 --- click here for more info or to register
Option 4: Enroll in Tobacco/Smoking Cessation Program --click here for more info
 

Option 5: For UPlan Members only - enroll with the UMD Health Coaching program ---click here to sign-up or for more info
 

Losing Battle Team Challenge
October 5-December 14

I am interested in receiving the (check one):

 *UMD Cookbook (Due to a limited supply, those who have already received a UMD Cookbook must choose a different gift.)
*UMD Employee Health & Wellness Center Imprinted Water Bottle
*Marathon Walker Socks

* while supplies last

Reset form button will delete all your entries

The University of Minnesota is an equal opportunity educator and employer.
© University of Minnesota Duluth
Last Updated: 11/27/09 03:10 AM
Comments: Judith S. Karon Webmaster: Lita C. Wallace

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