QLife 5K Walk/Run/Roll Completion Form
Employees and spouses on a Quad medical plan will get 500 points toward the QLife Wellness Rewards by submitting their Virtual 5K completion date and time.
Name
*
First Name
Last Name
Email
*
example@example.com
QLife Virtual 5K Completion Date (August 30-31, 2025)
*
-
Month
-
Day
Year
Date
Completion Time (How long did it take you?)
*
I completed the Virtual 5K Run/Walk/Roll:
In the United States of America
Outside the United States of America
What country did you complete the 5K in?
What State did you complete the 5K in?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
North Carolina
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Are you an Employee, Spouse, or Family/Friend of an Employee?
*
Employee
Spouse
Family / Friend of an Employee
Enter your Employee ID for QLife Wellness Rewards points
*
Enter your spouse's Employee ID OR your date of birth for QLife Wellness Rewards points
*
Would you be willing to share your story, photos or event time as a part of a QLife article on InsideQuad or Quad social media channels?
*
Yes!
No, thank you
Please share your QLife Virtual 5K Story:
Upload photos of your run or walk here! We'd love to see our Quad Family in action! Or you can email them to quadnews@quad.com
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Did you complete the Wellness Online QLife 5K Themed Activity Challenge?
Yes
No
Comments on the Wellness Online Activity Challenge
Any additional comments on this event you would like to share?
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