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UMD Wellness Log

Total Number of Miles or Minutes or Steps (100 miles OR 200,000 steps OR 1,500 minutes)

Name

Department

Campus Address

Campus Phone #

Complete E-mail Address (_____@d.umn.edu)

Choose One Gift (while supplies last):

	Undated Health Care-Toons Calendar
	UMD Wellness Walkers T-shirt size
		If T-shirt is selected, choose size
		S L XL XXL

Check all physical activities applicable

aerobics
backpacking
baking
bicycling
calisthenics
canoeing
carpentry
dancing
exercising
gardening

going up and down stairs
golf
home improvement
jogging
jumping rope
mopping floor
mowing (push lawmower)
raking
rowing

running
skating
sports
swimming
vacuuming
walking
washing car/windows
weight lifting
wood working

List all other physical activities not shown above

Reset form button will delete all your entries

The University of Minnesota is an equal opportunity educator and employer.
© 2008 University of Minnesota Duluth
2008
Comments: Judith S. Karon Webmaster: Lita C. Wallace

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