THE 50-50-50 CHALLENGE!

The following people have volunteered to participate by losing weight for pledges.  Check the box next to their name and fill out the pledge form below the pictures.

Niki Sampson Goal: 50 lbs Click to select:	Dave Sampson Goal: 30 lbs Click to select:	Craig Bass Goal: 20 lbs Click to select:	Laura Davis Goal: 10 lbs Click to select:
Victoria CB Trees Goal: 20 lbs Click to select:

I pledge the following amount up to the weight loss goal of the person I have selected above:
My first name:
My last name:
My mailing address:
City:
State:
ZIP:
My email address:
Would you like a copy of your submission form emailed to you? Yes  No (please allow several hours for the copy to arrive in your inbox)

Thank you very much for helping us meet our goal! 

Klamath-Lake Counties Food Bank
3231 Maywood Dr.
Klamath Falls, OR. 97603