http://www.recreation.ucla.edu/iheartwalking IHW Registration 2015 50% of survey complete. Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Gender Male Female Other Question Title * 4. Please indicate faculty or staff. Faculty Staff Student Other (please specify) Question Title * 5. Please enter your 9-digit Bruin ID # (found on your BruinCard): Question Title * 6. Department Question Title * 7. Email (Prize winners will be notified via email) Question Title * 8. Donate slightly used workout clothing and/or shoes to UCLA's FITTED student group and you'll be entered into a drawing for a pair of adidas running shoes. Yes No Question Title * 9. I will attend the following walks (select all that apply): Tuesday Feb 17: Women's Heart Health Learn at Lunch Wednesday Feb 18: General Heart Health Learn at Lunch Thursday Feb 19: Finale Event Question Title * 10. Due to high demand, we are no longer accepting reservations for Know Your Numbers on February 19. Question Title * 11. If you are selected for a prize, which items would you like to receive most? (select all that apply) University Credit Union (Smart TV) UCLA Computer Store (iPad Mini) Adidas Running Shoes Adidas Outdoors gift card Enzo's (meal for 4) Garlo's Aussie Pie (meal for 4) Gorilla Marketing (prize pack) LA Clippers (2 tickets 3/4/15) Jersey Mike's (meal for 4) Shop House (meal for 4) LA Kings (2 tickets 2/26/15) LA Galaxy (2 tickets 2/26/15) UCLA Men's Basketball (vs Washington 2/25) UCLA Health - bike UCLA Staff Assembly 5k - 2 free entries Water Tower Music - Soundtrack gift pack Container Store ($50 gift card) Any prize Question Title * 12. To assist with ordering sizes, what t-shirt size do you normally take? Note - shirts are gender neutral and sizes cannot be guaranteed. Small Medium Large Extra Large 2XL Question Title * 13. How did you find out about the 2015 I Heart Walking Week? Email Flyer Recreation Website Social Media Word of Mouth Other, please specify Question Title * 14. Are you currently a member of UCLA Recreation? If not check out our great packages at www.recreation.ucla.edu/newmembers Yes No In order to complete your registration, Please read the following waiver HERE and indicate below you have read and understood this document. Question Title * 15. I understand by agreeing, my signature is being transferred electronically, and I will not challenge the validity of the signature in any legal proceeding in which this document may be offered or used. Yes No Next