Gold Shoe Step It Up Challenge Registration and Newsletter Sign UP

* 1. If you've already registered click here to record your steps and activity.
The Gold Shoe Step It Up Challenge is a free community walking program designed to get Chemung County moving!!  Thanks to those that joined us for the initial screenings.
You can earn raffle ticket for prizes now by finding a Gold Shoe.
Prizes will be raffled off at our final event on Saturday, June 10th, at 10 am at Tanglewood Nature Center.
Please provide the following information to register:
All information is kept strictly confidential.
Thanks to those that joined us for the initial screenings.
Final screenings will be:
Monday, June 5th from 10 am to 2 pm at the Chemung County Health Dept. or
Thursday, June 8th from 5 to 7 pm at Arnot Mall
This is for those that participated in the initial screenings.

* 2. When were you born? Please enter as MM/DD/YYYY ie. 05/26/1971

Date / Time
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* 3. Which race/ethnicity best describes you? (Please choose only one.)

* 4. What is your gender?

* 5. Which initial screening will you attend? You must attend initial and final screenings OR find a Gold Shoe to be eligible for prizes. Initial screenings are 4/24 or 4/27. Final screenings will be in June.

* 6. Please answer yes or no:

  Yes No
Have you attended Gold Shoe or Step It Up activities in the past?
Have you been diagnosed with diabetes?

* 7. Please tell us your height and weight so we can track your progress - all information remains strictly confidential.  Please enter your height in inches.  For example, 5 feet 4 inches as 64 and your weight in pounds.

* 8. How did you hear about the Gold Shoe Step It Up Challenge? Check all that apply.

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