Win an iPod Touch! | Urban Health Plan iPod Contest

Be the lucky winner of a new 8 gb Apple iPod Touch!

Step 1: 'Like' us if you don't already.
Step 2: Fill out the form below.
Step 3: Click 'Enter Now' to submit your entry.

After submission you will be redirected to the Urban Health Plan Facebook page. Drawing 1/4/11. Notification 1/5/11 by email.

First Name: *

Last Name: *

Email: *

Street: *

City: *

State: *

Zip: *

Telephone:

Have you ever used UHP?: *

yes

Do you want to receive information about our events?: *

yes

INCREASE YOUR CHANCES OF WINNING!

You get your own new iPod Touch if a friend wins!
Enter three different email addresses in the spaces provided.

Help a friend win 1:

Help a friend win 2:

Help a friend win 3:

Duplicate entries will not be accepted. Attribution for multiple email referrals in the 'Help a friend win' portion of the contest will be awarded by time of submission. By submitting this form you are certifying that you are 18 years of age or older. Please do not provide emails of persons younger than 18 years. An email invitation from you will be sent to entrants and friends.