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Fittest Execs Application

Application deadline: March 21, 2008.
Once you are registered, you will be contacted by a representative to schedule your personal health and wellness appraisal.

* Indicates Required Field

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Nominee Info:

First Name *

Last Name *

Company *

Title *

Street Address *

Street Address line 2

City *

State *

UtahAlabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Postal Code / Zip *

Phone Number *

( ex: xxx - xxx - xxxx )

T-Shirt Size *

XS S M L XL XXL

Email Address *

Challenged By: (If Applicable)

Company *

Title *

Email Address *

Phone Number *

( ex: xxx - xxx - xxxx )

Fax Number

( ex: xxx - xxx - xxxx )

Street Address *

Street Address Line 2

City *

State *

UtahAlabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Postal Code / Zip *

Fitness Survey:
(Used for classification purposes. Will not be published.)

1. What does your fitness regimen consist of? *

2. What, if any, fitness clubs do you belong to? *

3. Other than the obvious health benefits, how has being fit improved your life? *

4. How does personal fitness affect your work life? *

Company Information:
(Used for classification purposes. Will not be published.)

5. Do you have a corporate health or wellness initiative? *

Yes No

6. Please describe your corporate health and wellness initiative

Annual Revenue

< $500k $500k - $1mil $1mil - $5mil $5mil - $10mil $10mil - $50mil $50mil - $100mil >$100mil N/A

Full Time Employees

< 5 5 - 10 10 - 25 25 - 50 50 - 100 100 - 250 250 - 500 > 500

Think you are more fit than your peers?

* The competition is limited to executives in the following positions: C-level, President, owner, partner, executive director, mayor/city manager/city council, retired executives or vice president level and above.

Send A Fitness Challenge