Thank you for your participation in the Go Walk Houston campaign! Please complete the following Registration Form to help us measure the impact of the campaign and to highlight and promote your success! 
Contact us at Gowalkhouston@houstontx.gov 
Share your activities on social media using #GoWalkHouston

Today's Date

Question Title

* 1. Today's Date

Date:
Organization Information:

Question Title

* 2. Organization Information:

Point of Contact Information:

Question Title

* 3. Point of Contact Information:

Sector of Organization:

Question Title

* 4. Sector of Organization:

Size of Organization:

Question Title

* 5. Size of Organization:

Does your organization currently have a workplace wellness policy or program?

Question Title

* 6. Does your organization currently have a workplace wellness policy or program?

GO WALK HOUSTON ACTIVITY DESCRIPTION
Please describe your fitness related project, program, policy, or activities in support of the Go Walk Houston Campaign. 

Question Title

* 7. GO WALK HOUSTON ACTIVITY DESCRIPTION
Please describe your fitness related project, program, policy, or activities in support of the Go Walk Houston Campaign. 

Is there a walking path, park, or trail on or near your worksite?

Question Title

* 8. Is there a walking path, park, or trail on or near your worksite?

Does your company’s physical location have bike racks?

Question Title

* 9. Does your company’s physical location have bike racks?

Average Age of Employees:

Question Title

* 10. Average Age of Employees:

Gender of Workforce (Estimation):

Question Title

* 11. Gender of Workforce (Estimation):

Race/ Ethnicity of Employees (Estimation):

Question Title

* 12. Race/ Ethnicity of Employees (Estimation):

T