The Award
Once you have completed the requirements for your chosen activity, you have earned your Mature Fitness Award USA! Your accomplishment will be rewarded with:

Your Mature Fitness Award USA Certificate of Achievement, personalized with your name and chosen activity, suitable for framing.

Your Mature Fitness Award USA Achievement pin to wear proudly on your lapel, hat or sweater.

 Award Registration Form

I have completed the Mature Fitness Awards USA requirements for the following activity:

(please print or type)

Name of activity: (As it will appear on certificate)
Name: (As it will appear on certificate)
City, State, ZIP:

Age: 50-59 _ 60-69 _ 70-79 _ 80+

Note: As a Mature Fitness Awards USA recipient, you agree to the use of your name for local and national publicity. Check here if you do not want your name used.

To receive your award, send your completed Activity Log and the Award Registration Form along with $7.95 shipping and handling to:

Mature Fitness Awards USA
c/o Mature Market Resource Center

328 West Lincoln Ave., #10
Libertyville, IL 60048-2725

Payment: All registrations must be prepaid by check, money order or credit card.

Check enclosed for $ ($7.95 per registration)

Make checks payable to: Mature Market Resource Center

Charge my: VISA __ MasterCard

Total $

Card # ___ Exp. Date (mm/yyyy)

Signature ________________________________________________________

Print Cardholder's Name ___________________________________________


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