Weight Loss Challenge Registration Form

60 Day Weight Loss Challenge

Begins June 11, meets weekly on Thursdays at 6:30pm at Healthy U
Please complete this Pre-Registration Form to secure your spot in the next Challenge.
Name

First NameLast Name
Email
example@example.com
Phone
How did you hear about the 60 Day Weight Loss Challenge

Other
If a friend, what is their name?
In order for us to find out what your Goals are, please specify below what you are expecting from this challenge, and why?
I want to improve in the following areas:
What is your why? (Is there an event you are working towards? or do you want to clean up your lifestyle?) Be specific!
We look forward to seeing your amazing results!!

David & Marilou Clary

Healthy U Coaches

CLICK THE LINK BELOW TO REGISTER
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