HEALTH CLUB REGISTRATION

Congratulations on taking control of your and your family's health!

The Kentucky Living virtual Health Club is located on a PRIVATE Facebook page that is not searchable by the public. As part of the registration process, you will be asked to provide your Facebook name/page.

If you do not currently have a Facebook page, please create one before beginning the registration process.

You have until Tuesday, January 15, 2013, to complete your registration.
Tell us about you and your family.
* First Name:
* Last Name:
* Street Address:
Address2:
* City:
* State:
* Zip:
*Phone:
(include area code)
Age:
Gender:
* E-mail Address:
NOTE: You will be sent a Friend request from a KL staff member.
When you accept the request, you will be added to the Health Club membership.
* Your Electric Co-op:
* Your Facebook Page:
(name or URL)
Describe your health goals.

Example:

My goal is to help my 12-year-old son lose some weight before it becomes a problem.

Action Steps:

  1. Increase his physical activity and limit his screen time through exercising 30 min. per day for five days a week.
  2. Involve him in grocery shopping and food prep to foster better food choices.
  3. Help him pack his own lunches 2-3 days a week to minimize poor choices at the school cafeteria.
  4. Involve the rest of the family in physical activities and healthier meals.
* What, specifically, do you want to change about your and/or your family's health?
* What steps do you plan to take to achieve these goals?
* 1.
* 2.
* 3.
4.
* Agree to the Rules of Engagement.
Please read and check each item.
I realize I will be sharing my personal information with other KL Health Club members and staff, and that I'm okay with that.
I also acknowledge that any information I post may be published in the magazine or elsewhere, and I grant the use of it without restriction.
The healthcare professionals on this site are not treating me as a patient and I will not hold them to traditional HIPAA laws, but will accept their expertise to help me reach my health goal.
I will not share anyone else's health information, whether I know them or not, and I have the right to expect that they will not share mine. Nor will I copy, repost, tweet or otherwise distribute information posted by other Club members.
I will be polite and respectful in interacting with KL Health Club members and staff. I will not use profanity or make negative comments.
While I can mention what I do for a living if related, I will not promote, sell or post about my products or services on the KL Health Club site.
Kentucky Association of Electric Cooperatives (KAEC) and Kentucky Living magazine promise to you:
We will keep your name and contact information on file, but will neither sell nor loan it to a third party, though we may, from time to time, contact you in the future for magazine-related purposes.
You will always have the ability to opt out by letting us know that you wish to unsubscribe from further contact from us.
We will do our best to provide accurate attribution if we publish or otherwise use information you post, be we cannot guarantee that we will be able to provide acknowledgement in connection with all uses.

No purchase necessary. Eligibility: Contest open to all persons age 18 and over, except employees and their immediate family members of the Kentucky Association of Electric Cooperatives, and Kentucky electric cooperatives; and their respective divisions, subsidiaries, affiliates, advertising and promotion agencies.