Apply to become a Priority Health Champion 2021

4. Is this your first year being a Priority Health Champion?

• Yes, this is my first year in the program.
• No, I have been a Priority Health Champion in previous years.

Gender *This question is required.

• Male
• Female
• Other - Write In Please enter an 'other' value for this selection.

Using the maps below, what area of Michigan are you from? (select one) *This question is required. Please select one of the following images.

Not Selected

Not Selected

Not Selected

Not Selected

How often do you do physical activity? *This question is required.

• Less than 1 hour per week
• 1-3 hours per week
• 4-10 hours per week
• 11-20 hours per week
• 21+ hours per week

Are you a Priority Health or Spectrum Health employee? (not a requirement for the program) *This question is required.

• Yes
• No

Do you have Priority Health insurance? (not a requirement for the program) *This question is required.

• Yes
• No

Are you registering anyone under the age of 18? *This question is required.

• Yes
• No

5. Can we use your photo? (view release here) *This question is required.

• Agree

6. I agree to the terms and conditions of the Champions program. (view release here) *This question is required.

• Agree