* 1. First Name

* 2. Last Name

* 3. Street Address

* 4. Apt./Suite

* 5. City

* 6. State

* 7. ZIP code

* 8. Email

* 9. Phone

* 10. Which #INGreenwaysChallenge do you intend to complete? 

* 11. What social media platform will you use to complete the challenge?

* 12. Please provide your name or handle for the social media platform you plan to use to complete the challenge.

* 14. Check all that apply. 

* 15. I understand the #INGreenwaysChallenge is a voluntary incentive program. The Greenways Foundation of Indiana is not responsible for injury, property damage, or other loss associated with completion of the challenge.

* 16. I understand the #INGreenwaysChallenge requires me to self-report my progress using social media and the proper hashtags. All challenges must be completed by Oct. 31, and I am responsible for notifying the Greenways Foundation of Indiana via email (info@greenwaysfoundation.org) upon completion in order to receive prizes.

* 17. I give consent to the Greenways Foundation of Indiana to subscribe me to their email newsletter, to contact me regarding the challenge and to solicit tax deductible donations. The Greenways Foundation of Indiana does not share contact information with others.

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