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Lose-A-Thon: Register

There are two steps to registering, which include filling out this form and creating your FirstGiving donation page.  After you register you will be prompted to create your Firstgiving donation page and automatically invited to join the Lose-A-Thon Online E-group.

The information provided here will not be shared. By providing your email address, you are allowing us to communicate with you about Lose-A-Thon.

The information requested here will be used on your personal web page.

*Participant/Team Name:   
As it will appear on the web site (i.e. Smith, Jane; Grisly High School Team)
*Your City and State:   
Example: Buffalo, NY
*Your Telephone Number:  
Example: (xxx) xxx-xxxx
*Your E-mail Address:   
Example: yourname@123.org
*Goal: Pounds
 Percentage of Body Weight
*Pounds or Percentage You Want to Lose:   
*Why you want to participate (write it as you want it to appear):
 
*Your Name or Team Leader:  
Example: FirstName LastName

* All fields are required

*Disclaimer: Information on this website pertaining to diet and exercise (including but not limited to Lose-A-Thon information) is intended only to assist users in their personal weight management efforts. PWSA (USA) is not a medical organization and our staff cannot give you medical advice or diagnosis. Nothing contained in this website should be construed as such advice or diagnosis. The information and reports generated by us should not be interpreted as a substitute for physician consultation, evaluation, or treatment.

You are urged and advised to seek the advice of a physician before beginning any weight loss effort or regimen. Information on this website pertaining to diet and exercise (i) is intended for use only by healthy adult individuals; and (ii) is not intended for use by minors, pregnant women, or individuals with any type of health condition. Such individuals are specifically warned to seek professional medical advice prior to initiating any form of weight loss effort or regimen.

 

edited:06/10/2009

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