I’m Engaging in Good Health!

DowFriends

I’m Engaging in Good Health!

Please tell us about your participation in events, activities, and programs that help you engage in good health. Examples include fitness programs such as the President’s Challenge, health education presentations such as MUST for Seniors, and/or health-related activities such as a community walk or health fair. These are just examples; we want to hear about anything that you are doing to promote good health for yourself and others.

Qualify for the “Wall of Good Health”
Retirees reporting three or more events, activities, and/or programs in which you participate will be recognized on the “Wall of Good Health,” a special area in the Hall of FAME on the DowFriends website. If you give your permission below, we will post your name and picture, along with your list of events*.

Even if you prefer not to be recognized publicly, we still want to know what you are doing! So please, take a few minutes to complete the information below, and tell us how you are engaging in good health!

*Please note that other information requested below will not be shared outside of Dow Health Services and will only used by Dow Health Services to support your efforts and, in aggregate, to monitor the success of the Retiree Health Empowerment Program.

Email Form

First Name^‡

Last Name^‡

Dow ID Number^‡

• If you are a retiree, please use Dow/UCC employee number followed by R – Example: 286958R

• If you are a retiree family member, please use Dow/UCC employee number followed by D – Example 286958D

Address

City

State

Zip

Phone

(Include Country/Area Code)

Email Address^‡

Name of Event^‡

Date of Event (or date started)^‡

Location of Event^‡

How did you first hear about this event/program?^‡

Share Your Healthy Ideas! Do you have an interesting example or idea for being engaged in good health?

YES! I wish to be recognized on the DowFriends Wall of Good Health.

(To be eligible, you must report your participation in at least three health-related events this year.)

YES! I would like to receive Retiree Health Program information by email.

(Please provide your email address above.)

^‡ Required Field