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Maine Governor's
Council of Physical Activity Membership Form
Help make Maine the
healthiest state in the nation by becoming a Supporting Member of
the Maine Governor’s Council on Physical Activity.
Your tax deductible membership dollars
will help support:
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Advocating
for health-related policies that will reduce barriers and create
opportunities for Mainers to be more physically active.
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Creating
model statewide physical activity programs that will ultimately
improve the health of Maine residents by reducing their risk for
obesity and other related chronic diseases.
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Increasing
public awareness of the importance of daily physical activity
through media events, legislative advocacy, and collaboration
with colleagues statewide.
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Current
Council events and activities (see programs and events page for
more details).
To become a
Supporting Member, please fill in the information below.
(printer-friendly
version)
Annual Supporting Membership
Categories:
OR an
Exemplary Supporting Member Amount:
$
All contributions are tax deductible.
Membership Benefits:
(you will receive all the below with your membership unless you indicate your desire not to receive it by clicking on the corresponding box)
Name listed on
web site and annual report.
Monthly Maine in
Motion e-newsletter.
Periodic
announcements of Council events, programs, and physical activity
news.
Council
bi-annual newsletter.
Invitation to
annual business meeting.
My Interest Is (click all that apply):
Networking
Being a member of
a committee (for more information on Council activities, go to
www.maineinmotion.org)
Supporting
Council events
Current
Information on wellness and physical activity
Other:
Payment Method:
Check
will follow in the mail.
After you have finished this registration form, you will
receive directions on where to remit your payment to.
I'd
like to pay by credit card.
After you have finished this registration form, you will be
brought to a secure payment form online.
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