THE 50-50-50 CHALLENGE!

If you would like to participate by losing weight along with me and/or getting your friends and coworkers to pledge for your loss of pounds, please fill out and submit the following form.

Please consult your physician before beginning any diet or exercise program.

First name:
Last name:
Mailing address:
City:
State:
ZIP:
Enter your weight loss goal: lbs.
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