Moai Registration Form
Please complete this Moai Registration form to register your existing group as moai with the Blue Zones Project.
Best Phone Number
Home Zip Code
Work Zip Code
Group's name and number of participants
I coordinate the group or can provide contact info
I pledge to participate in the Blue Zones Project.
Check if you have done or will do one of these actions. Participating in a moai is your first action to live longer better.
The full pledge is available at bchd.org/bzp
I will join a walking, purpose or potluck moai.
I will discover my purpose.
I will eat wisely and stop when 80% full.
I will designate my home as a "Smoke-Free Zone."
What motivates you to participate with your group as a moai?
Social connections and making new friends
Making positive and healthy behaviors a priority
Supporting the Beach Cities to become a national model for well-being
How did you hear about moai groups?
I've parcticipated in the past
From current moai participants
From friends, family or colleagues
My worksite wellness program
Beach Cities Health District bchd.org
Blue Zones Project event or postcard
Local media or community bulletins
Other - how did you hear about moais:
What is your group activity?
Check all that apply
Arts & Crafts
Parent & child group
Group Meeting Details
Moai groups meet weekly or monthly for 30 minutes or more.
Where does your group meet?
Redondo Beach (North)
Redondo Beach (South)
Early morning (7:00-8:30am)
Send me a copy of my responses
Smartsheet Web Forms
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