Get Fit Pledge

Print
Press Enter to show all options, press Tab go to next option
Please correct the field(s) marked in red below:

1
My health is important to me, my family, and my community. To do my part, I am willing to:
 *
My health is important to me, my family, and my community. To do my part, I am willing to:
2
I would like to receive a monthly email alerting me of new Get Fit information and be entered into a monthly drawing for Get Fit GP prizes.
 *
I would like to receive a monthly email alerting me of new Get Fit information and be entered into a monthly drawing for Get Fit GP prizes.
3

Your Name

 *
4

Email (Please enter your e-mail address if you would like to receive a monthly email with news, info and ideas on how to stay fit and be entered into the monthly drawing for prizes.)

5
How did you hear about the "Get Fit Grand Prairie" program?
 *
How did you hear about the "Get Fit Grand Prairie" program?
  1. To receive a copy of your submission, please fill out your email address below and submit.
    CAPTCHA
    Change the CAPTCHA codeSpeak the CAPTCHA code