Register for Lighten Up

Team & Individual Registration
Fill in the form below to register your 4-member team for Lighten Up 4 Montgomery.

If you are registering as an individual, fill in your information as "Team Member 1" and state "individual" after your name.

All entry fields with an asterisk (*) must be filled.

If you are registering as an individual put an "X" in each unused entry field.

Business or organization name (if applicable):

Lighten Up Montgomery County team name (choose a name): *

Information for Team Member 1 - First and last names and gender (F or M): *

Member 1's Phone No. AND email address: *

Member 1's Beginning Weight: *

Information for Team Member 2 - First and last names and gender (F or M): *

Member 2's Phone No. AND email address: *

Member 2's Beginning Weight: *

Information for Team Member 3 - First and last names and gender (F or M): *

Member 3's Phone No. AND email address: *

Member 3's Beginning Weight: *

Information for Team Member 4 - First and last names and gender (F or M): *

Member 4's Phone No. AND email address: *

Member 4's Beginning Weight: *