Pounds for Pennies
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Telephone Number
*
Participant ID Number (last 5 digits of your telephone number)
*
Current Age
*
Please Select
Doll (18-39)
Diva (40-61)
DEAR (62+)
Please provide the numbered scale you are weighing in on or INDICATE IF IT'S A HOME SCALE. (Weighing-In Soror will give you this information. Please use this scale for each weigh-in.)
*
Your answer
Starting Weight
*
Current Wellness Goal
*
Maintenance (stay within 1-2 pounds of my current weight
Weight Loss
Weight Gain
Would you like to be included in the Pennies for Pounds Community/Groups for Tips and Support throughout the challenge?
Please Select
Yes, I would love Support from my Sorors.
No Thank You, I would like to do this on my own.
Registration Fee
prev
next
( X )
PayPal Transaction Fee
$
0.49
Registration Fee Pounds for Pennies ($22 + $1.30 PayPal - .49 fee) $22.81
$
22.81
loading smart payment buttons...
The payment is ready! It will be completed once you submit the form.
Should be Empty: