* 1. Please provide your first and last name:

* 2. Where do you work?

* 3. Please provide a phone number to reach you (for prizes!):

* 4. Week of Challenge

* 5. Saturday Physical Activity Minutes

* 6. Sunday Physical Activity Minutes

* 7. Monday Physical Activity Minutes

* 8. Tuesday Physical Activity Minutes

* 9. Wednesday Physical Activity Minutes

* 10. Thursday Physical Activity Minutes

* 11. Friday Physical Activity Minutes

* 12. What type of activities did you perform for physical activity this week?

* 13. Did you increase your level of physical activity this week?

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