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Patron Incentive Program Registration
Fall 2015 Patron Incentive Program Registration
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* Indicates required question
Name (First)
*
Your answer
Name (Last)
*
Your answer
Email
*
Preferably WM email if availble
Your answer
Age
*
Your answer
Gender
Your answer
Campus Rec Affiliation
*
Freshman
Sophomore
Junior
Senior
Graduate Student
Faculty/Staff
Privilege Card Member
How would you rate your activity level on a weekly basis?
*
1- No Activity (0 times a week)
2- Very Little Activity (0-1 times a week)
3- Very Little to Some Activity (1-2 times a week)
4- Moderate Activity (2-3 times a week)
5- Active (3-5 times a week)
6- Very Active (5+ times a week)
How many steps per day do you think you currently walk?
*
Your answer
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