Sign the Declaration

If you need assistance filling out this form contact us info@steppinguphalifax.ca

Contact Information

We do not know who you are. Please supply your name and email address. Alternatively you can log in if you have a user account or register for a user account if you do not have one. Registering for a user account will allow you to edit your submission in the future.

Name:
(Required)

Email:
(Required)

Phone number (Required):

Mailing Address (Required):

Organization Name (Required):

Website Address:
URL:

Upload Company Logo

Upload Photos

What inspired your organization to “step up”? What are you doing? (Required):
Allowable Tags:

What factors were keys to your success?
Allowable Tags:

What was the impact/outcome? What has changed for your organization? (Required):
Allowable Tags:

Yes, I would like to receive a hard copy of the strategy.

How did you hear about Stepping Up?

If other, specify:

Additional information
Allowable Tags:

Do you wish to receive information about physical activity?

Please review our privacy policy.

Stepping Up Halifax

A Physical Activity Strategy for the Halifax Region

Sign the Declaration