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Apply to become a Priority Health Champion -

Apply to become a Priority Health Champion

3. Is this your first year being a Priority Health Champion?
This question requires a valid date format of MM/DD/YYYY.
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5. Gender *This question is required.
This question requires a valid email address.
This question requires a valid number format.
11. Using the map below, what part of Michigan are you from? *This question is required.
12. How often do you do physical activity? *This question is required.
16. Are you a Priority Health or Spectrum Health employee? (not a requirement for the program) *This question is required.
17. Do you have Priority Health insurance? (not a requirement for the program) *This question is required.
18. Are you registering anyone under the age of 18? *This question is required.
19. Champion kid #1
Gender *This question is required.
Add another Champion kid?
19. Champion kid #2
Gender *This question is required.
Add another Champion kid?
19. Champion kid #3
Gender *This question is required.
Add another Champion kid?
19. Champion kid #4
Gender *This question is required.