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Active Living Coalition for Older Adults
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Order Form for ALCOA Resources

New CD Tool Kit Resource for Healthy Living Workshops

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Please complete the following form and submit it to ALCOA for processing.

Name of Organization
Address Line 1*
Address Line 2
Postal Code*
The Tool Kit is in a CD format, and contains all the information, step by step guide, resources, posters, video links, etc. to allow you to offer an evidence-based Healthy Living workshop for Older Adults. “Your Personal Passport to Healthy Living” is the resource to be used by the participants in the workshop and come packaged in bundles of 10. As this Tool Kit is designed to be used in a workshop setting, the maximum number of Passports that can be ordered is 2 bundles (i.e. 20 Passports). Should more Passports be required please contact the office at At this time there is no charge for the Tool Kit and Passports.
Passport Bundles reorder only. No CD required.  
Number of bundles required*
Anticipated date(s) of courses
Please continue to send me occasional e-mail blasts about ALCOA resources  
No. I do not wish to receive occasional ALCOA e-mail announcements  
Follow up Evaluation:
It is important for ALCOA to be able to evaluate the impact of our resources. As our supplies are limited, at this time we will only send out the material for use in a 6-week workshop setting. We would also ask that you agree to have your participants complete the Evaluation Survey in the back of the Passport, and return them to the ALCOA office.
I agree to return the completed participant surveys to ALCOA following my 6-week workshop.  
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Last modified: March 13, 2016
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