Exit this survey >> Inter Agency Greatest Loser Mid Point 2017 - San Bernardino County Disclaimer: your response will be shared with a 3rd party and employer in order to administer an incentive. Question Title * 1. Please enter your department's name below. Question Title * 2. Team Captain name and contact information (please use your work information NOT your personal information): Name: Work Email: Work Address: City, State, Zip: Work Phone Number: Question Title * 3. Team Name:(The same name selected at registration, team name will stay the same during the contest, i.e. Biggest Losers, Gut Busters, etc.). Question Title * 4. Number of Team Members:The team must be the same number of team members you started the campaign with.(Select the number of team members on your team from the drop-down list, 1-15). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Question Title * 5. Total team weight during the week of February 27th - March 5th, 2017(Enter the total number of pounds your team weighs. Refer to your tracking template).If a member of your team did not weigh-in or dropped out, then please include and roll over his/her initial weight. Next >>