Register for Lighten Up

Team Registration (4-member teams)
Fill in the form below to register for 'Lighten Up 4 Montgomery' by email. You may also use this form to register as an individual. Fill in your information as "Team Member 1." State "individual" after your name.

All entry fields with an asterisk (*) must be completed. If not reporting for a team, for example, as an individual, or for fewer than all team members, put an "x" in unused entry fields.

Business or organization name (if applicable):

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

Information for Team Member 1 (first and last names): *

Gender: *
Male
Female

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

Member 1's Beginning Weight: *

Information for Team Member 2 (first and last names): *

Gender: *
Male
Female

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

Member 2's Beginning Weight: *

Information for Team Member 3 (first and last names): *

Gender: *
Male
Female

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

Member 3's Beginning Weight: *

Information for Team Member 4 (first and last names): *

Gender: *
Male
Female

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

Member 4's Beginning Weight: *

Lighten Up 4 Montgomery

- Lighten Up 4 Health, Lighten Up 4 Life