"Mom-inate" a mom as Chief Health Officer by completing the entry form below and upload a 30-second video explaining why your mom, maternal guardian, or a mom you know should be named America's Chief Health Officer - and be sure to explain how milk plays an important role in your family's diet!

Don't have a video camera? No problem! Just submit an essay (50-words or less) explaining why the mom you know is worthy of the title, Chief Health Officer, by typing your entry in the field below.

In October, 100 finalists will be posted online and America will be invited to vote for the mom they think best represents America's Chief Health Officer. Ultimately, one grand prize winner will be rewarded with the chance to star with her family in a Milk Mustache ad, plus a year's supply of milk, a three-month complimentary Curves membership and a one-year subscription to Redbook.

Chief Health Officer Entry Form

First Name

Last Name

Address

City

State

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Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP

Date of Birth
You must be 13 years or older to enter.

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January February March April May June July August September October November December
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
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2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Phone
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Email

First Name of Mom Being Submitted

Last Name of Mom Being Submitted

Video:


50-Word Essay:


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