New York State Physical Activity Coalition c/o Wellness Institute of Greater Buffalo

Create Account

Welcome to the MOVE 4 LIFE! account registration area. With your free account you may access all information and materials for the MOVE 4 LIFE! program. To register, fill out the applicable fields and especially those required fields. Your account information will be emailed to you for your records.

* Please note - the organization name should be the "name" you wish your participants to register under when they create their account on the participant side of the website. (Ex: XYZ Company, Hillside School District, Mr. Smith's Period 4 PE Class, North's Community Health Initiative, St. John's Church in Littlevalley,NY)

*Denotes Required

*Organization Name:
*Contact First Name:
*Contact Last Name:
*Contact Email Address:
*Contact Title:
*Complete Work Address:
*County where Organization is located:
*City:
*State:
*Zip:
*Work Phone with Area Code:	Ext.
Work Fax with Area Code:	Ext.

CEO/Owner First & Last Name:
Company Website Address:
Approximate # of Employees employed by Organization:
*Type of Industry grouping:
Other Type of Industry:
	(Fill in if Other is selected above)

Is the Organization Self Insured?
Does the Organization have an existing wellness program?
*How did you hear about MFL?
Other:

*Create a Username:
*Create a Password:
*Verify Password: