Pre-registration

What: 2 mile Walk/Run
Where: St. Croix, St. Thomas, St. John
When: November, March, June

* Personal Information

* Sex:

* Please provide:

* I will walk/run in (place a check mark (√) the appropriate box):

* Yes, I support WTJX’s Obesity Campaign and I will provide some basic information about my exercise and eating habits to complete the registration for the Walk/Run event.

Please read the following questions and place a check mark (√) the appropriate box:

1. How many days a week do you exercise?

* 2. How many minutes do you exercise per session?

* 3. What type of exercise do you do most often?

* 4. How many cups (8 ounces) of water do you drink a day?

* 5. How often do you eat breakfast in a week?

* 6. How often do you drink sugary beverages (soda, malt, juice drinks) and/or eat
unhealthy snack foods (cookies, tart, candy)?

* 7. How often do you eat healthy meals with lots of vegetables and fruits?

* 8. How often do you eat fried foods, dressings, sauces, gravies, butter and margarine?

* 9. Do you primarily eat whole grains instead of white pasta, white rice and white bread?

* 10. Do you read the Nutrition Facts labels of the foods you buy?

Please help spread the word to family and friends about the WTJX’s Obesity Campaign. Encourage your family and friends to register for the Walk/Run by logging on to: http://virginislandspace.org

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