Worldwide

Please tell us about your participation in events, activities, and programs that help you engage in good health.  Examples include fitness programs, health education presentations, support groups and/or health-related activities such as a community walk or health fair.  These are just examples; we want to hear about anything that you are doing to promote good health for yourself and others.

Your story may be selected to appear in the Retiree Good Health Stories on the DowFriends website.  If you give your permission below, we will post your name and picture, along with your Good Health Story*.

Even if you prefer not to be recognized publicly, we still want to know what you are doing!   So please, take a few minutes to complete the information below, and tell us how you are engaging in good health! 

*Please note that other information requested below will not be shared outside of Dow Health Services and will only used by Dow Health Services to support your efforts and, in aggregate, to monitor the success of the Retiree Health Empowerment Program.


Email Form
First Name
Last Name
Dow ID Number
• If you are a retiree, please use Dow/UCC employee number followed by R
   – Example: 286958R
• If you are a retiree's spouse/partner/widow, please use Dow/UCC employee number followed by D
   – Example 286958D
Address
City
State
Zip
Phone
 (Include Country/Area Code)
Email Address
Name of Event/Activity/Program
Date of Event/Activity/Program (or date started)
Location of Event (if applicable; otherwise enter n/a)
How did you first hear about this event/activity/program?
Share Your Good Health Story! How are you engaging in good health?
 YES! I wish to have my Good Health Story appear on DowFriends.com
(You will be contacted about providing a digital photograph of yourself to go with your story)
 YES! I would like to receive Retiree Health Program information by email.
(Please provide your email address above.)

Enter the code as it is shown (required):

 Required Field

Data Privacy and Protection

The information collected in this form will only be used to ensure that we provide you with an appropriate response based upon the information you provide in the form above. We will contact you only if we need additional information to appropriately answer your question or in order to address your need. The contact information you provide, including e-mail address, may be used to respond to your request. We will not use the contact information you provide in this form for product or promotional advertising unless you specifically request to receive product news or information.

For more information, please review our Privacy Policy.