30 DAY WEIGHT-LOSS CHALLENGE Entry Form

30 DAY WEIGHT-LOSS CHALLENGE Entry Form

Please complete the form below to officially sign-up for our annual weight-loss challenge. Please make sure to read and follow all of the rules listed below. Failure to follow the rules will result in automatic disqualification, and your mandatory deposit will not be returned. Keep it fair, have fun, and good luck to everyone!
Contestant Information
Full Name *

First Name Last Name
E-mail *
Phone *
Title/Position *
This helps us know who participates in our company events.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country (if not USA) *
Notes:
INITIAL WEIGHING APPOINTMENT *
FINAL WEIGHING APPOINTMENT *
Entry Fee Payment

In order to join, there is an entry fee of $10 for each contestant.
Check the box if you have read and fully understood the rules. *

I will provide a cash payment of $10 to the office.
By signing this form, you are agreeing to the terms and conditions of this competition. *

*NOTE: THE FULL CONTRACT IS FOUND ON THE CARING HEART WEBSIT Clear
Email *
example@example.com
Should be Empty: