Registration Form

Weight Loss Challenge & Nutrition Class Challenge.

Next Session Orientation: Tues. & Wed. Feb. 21 & 22nd
Classes start Tuesday & Wednesday
February 28 & 29

154 Martin Rd. Fremont, NH 03044
above the Tack Shack at Brookvale Pines Farms

Tuesday 7:00-8:00 pm
Wednesday 11:00 am - Noon (or 7:00-8:00 pm)

Wednesday 5:30-6:30 pm
(must complete and pass Beginner Class to qualify.)

Once you submit this form and follow the directions you receive
you will be registered for our next class.

Fill out registration form and hit submit.

Name:

Spouse:

Child 1:

Child 2:

Phone :

Email:

Address:

City: State:

Zip:

Which Class Would You Like to Register For?

* You MUST take Beginner Class before you can take the Advanced Class.

** FAMILY RATE is as follows ONLY: $50.00 for you and $20 each for your spouse and children (under the age of 18) living with you.

Do you have weight you'd like to lose?

How Many Meals Do You Eat Daily?

Do You Exercise?

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