This e-form is to be completed for the month of September.

September 2017
  • E-form to be completed between September 29-October 3.
  • The drawings will take place on Wednesday, October 4.

What is your last name?

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* 1. What is your last name?

What is your first name?

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* 2. What is your first name?

What is your work email?

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* 3. What is your work email?

Where do you work?

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* 4. Where do you work?

I attest the following is true (fill in circle next to statement):

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* 5. I attest the following is true (fill in circle next to statement):

Did you take the time to make at least one of the recipes posted on www.fcciwellness.com during the month of August? If you mark 'Yes', your name will be entered twice for the drawing (increasing your odds of winning)! NEW! Please write in the comment box which recipe you prepared on your own.

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* 6. Did you take the time to make at least one of the recipes posted on www.fcciwellness.com during the month of August? If you mark 'Yes', your name will be entered twice for the drawing (increasing your odds of winning)! NEW! Please write in the comment box which recipe you prepared on your own.

Quiz question: Check off the one that does NOT apply. Lentil facts:

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* 7. Quiz question: Check off the one that does NOT apply. Lentil facts:

True or False: Onions are a source of chromium which is beneficial for blood sugar control.

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* 8. True or False: Onions are a source of chromium which is beneficial for blood sugar control.

Please share any comments about September's Challenge, Be Good to Your Gut, or the Healthier by Design Challenge in general.

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* 9. Please share any comments about September's Challenge, Be Good to Your Gut, or the Healthier by Design Challenge in general.

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