Share an Exercise Story

NIHSeniorHealth.gov is a U.S. government web site for older adults that provides reliable health information. Staff from the National Institute on Aging (NIA) and the National Library of Medicine (NLM), both part of the National Institutes of Health (NIH), developed this site. If you are age 60 years or older and exercise regularly, we invite you to send us your story for the NIHSeniorHealth.gov Web site. You should write your own story in your own words. We would also like to post a photo showing you exercising.

By filling out the form below, you are giving the NLM permission to use and disclose the information you submit on the NIHSeniorHealth.gov web site and for any future purposes. *See full Disclaimer below.

Instructions

1. Form:

Please print out this form and fill out the information below, check the appropriate exercise activities, and write the exercise story (150 words or less). You can mail the completed form to:

NIHSeniorHealth.gov - Exercise Story
National Library of Medicine
Bldg 38 Rm 1W22
8600 Rockville Pike
Rockville, MD 20894

2. Photo:

Send us a photo of the older adult exercising. We will put the photo with the story on the web site. You can mail the photo with the form. Because of the large number of entries we receive, we cannot return your photo.

Remember

• The older adult must be 60 years of age or older.
• The photo! You can mail it with the attached form or send it to us by e-mail to nihsrhealth@nlm.nih.gov.
• We will not send the photo back to you. Please choose one that you can give us permanently. Be sure that the photo you send is one that you own and is not copyrighted by someone else.
• The personally identifiable (e.g. full name, phone number) information you give us on the attached form is for our use only in case we need to contact you. It will be maintained in compliance with the Federal Privacy Act (5 USC 552). For additional information on NLM's privacy policy, please see the following http://www.nlm.nih.gov/privacy.html.
• We may not use every story that is sent to us.
• We may edit the story.
• We cannot use stories that endorse particular name brands.

Share An Exercise Story

* See Disclaimer Information below

Contact Information:

Date: ___________________________________________________

First Name: _____________________________________________

Last Name: ______________________________________________

Age: ____________________________________________________

Email Address: ___________________________________________

Phone: __________________________________________________

State (e.g. Maryland): __________________________________

Exercise Story (choose any that apply)

Activities:

Write the Exercise Story Here (150 words or less):

Print and mail the form and photo to:

NIHSeniorHealth.gov - Exercise Story
National Library of Medicine
Bldg 38 Rm 1W22
8600 Rockville Pike
Rockville, MD 20894

*Disclaimer

The placement of advertisements or solicitations will not be accepted, and the material you submit, including photographs, must be true to the best of your knowledge, original, and must not have been copied or derived from any material not owned by you. The National Library of Medicine will review the information prior to posting it but will not approve, endorse, or verify the accuracy of the information. You agree to hold the Library, and others acting on its behalf, harmless for any claims or liability arising out of the Library's use of the material. While you retain the rights to the material you submit, you agree further that it may be displayed on the NIHSeniorHealth.gov web site and used by the Library for any future purpose. Because of the volume of submissions, not all stories will be immediately available or available indefinitely. By providing this information, you give your permission to associate your name with your comments.