Governor's Council
on Physical Fitness, Health and Sports
and the
Michigan Fitness Foundation

Endorsement Application

The Governor's Council on Physical Fitness, Health and Sports was founded to promote the health benefits of physical activity.  Individuals who are physically active have lower rates of heart disease, stroke, colon cancer, breast cancer, and osteoporosis as compared to those who are inactive.  Therefore, the Council endorses local, regional, or statewide events that have sound physical activity consistent with its mission to Get Michigan Moving.

Please fill out the following request for endorsement and allow three weeks for processing.  Please type or print all answers.  If this request for endorsement is approved, the Council will provide a logo, which must be used in all promotional material.  The Council may also provide certificates of participation.  Events which the Governor's Council endorses will be promoted on the Governor's Council/Foundation website at www.michiganfitness.org.

Organization Information
Event/program name:
Event date(s):
Presenting organization:
Primary contact:
Title:
Organization:
Address:
Phone:
Fax:
Email:
Alternate contact:
Organization (alternate):
Address (alternate):
Phone (alternate):
Fax (alternate):
Email (alternate):
Event/Program Endorsement Criteria
The following criteria will be considered in the endorsement application process.  Check all that apply to your event/program.
The presenting organization/event host has good credibility with its constituents and event/program participants.
The event/program will provide a positive experience for its participants.
The event/program will be conducted by qualified officials (if applicable).
The applicant will provide a safe environment for its participants.  Appropriate safety equipment will be worn by all participants (e.g., helmets in bicycling events and shin guards in soccer events).
Adequate and appropriate medical supervision and support, including emergency preparedness, will be provided during the event/program.
The presenting organization/host will  have liability insurance for the event/program and will inform participants of their responsibility to obtain personal injury insurance.
Sponsors of the event/program will not produce and/or sell alcohol or tobacco products as their primary business.
The event/program will be presented/hosted by a nonprofit organization and will be operated on a self-supporting financial basis with any proceeds going to a nonprofit or charitable organization.
Event/Program Information
Type of event (check all that apply):
Competitive sports event Sports clinic Sports camp
Fitness event (participants are physically active) Health/fitness fair
 Other:
Event/program description (list sports if applicable):
Event/program purpose:
Number of years event/program has been held: 
Has this event/program received previous endorsement from the Council?  Yes No
Location of event/program (city and county):  
If multiple sites, list all cities and counties:
Participant Information
Estimate number of participants:  
Age range of participants:
Description of participants (check all that apply):
Experienced athlete Occasional athlete Non-athlete/new participant
Adult male Adult female Senior citizen (over 60)
Youth (ages 12-18) Children (under 12)  
Does your event seek to involve any of the following?
Physically disabled Developmentally disabled Sedentary population
Sponsor/Promotion Information
Is your event/program sponsored by companies that produce or sell alcohol or tobacco products as their primary business? Yes No
Please list your financial and in-kind sponsors:
How is your event/program promoted?  (Check all that apply.)
Direct mail Press releases Paid advertising
Public service announcements Through sports/club networks Web site
 Other
 
Describe your role with the presenting organization or host:

Liability Disclaimer

All liability to third parties, loss or damage as a result of claims, demands, costs, or judgement arising out of activities to be carried out by the program presenter/host are the responsibility of the presenter/host and not the responsibility of the Governor's Council on Physical Fitness, Health and Sports or the Michigan Fitness Foundation.

Endorsement of the proposed event/program does not constitute endorsement of the presenting or sponsoring organization or the products used during the event.

Verification and Signature

I verify that I have read the Event/Program Endorsement Criteria and certify that the above event/program meets all minimum requirements.  Therefore, I request the endorsement of the Governor's Council.  I understand that if granted, the endorsement is awarded on a one-time-only basis and I must re-apply for future endorsement.  If at any time the presenting/host organization changes and the event/program no longer meets the minimum criteria for a Council endorsement, the Governor's Council will be notified immediately in writing.  I further certify that I am authorized to sign this application on behalf of the presenting/host organization.

______________________________________________________________________
signature                                                                                                                    date

______________________________________________________________________
printed name

 

______________________________________________________________________

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Supporting Materials/Enclosures

Please enclose the following materials with this application:

Notification

You will be notified within three weeks of receipt of these materials whether or not your application for endorsement has been approved.

Questions?

Please call the Governor's Council/Foundation office at 800/434-8642 or 517/351-8959.

Submission of Materials

Return this application and supporting materials to:

Governor's Council on Physical Fitness, Health and Sports
P.O. Box 27187
Lansing, MI  48909

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