Complete the below if you have finished your 21 Day Challenge

Complete this form if you successfully finished the “21 Day Challenge.”  You will be entered into an ongoing monthly raffle drawing.  Once you submit, you will have a chance to win the every month thereafter in 2020.  Earn a raffle entry for each “21 Day Challenge” you complete.  Winner required to show daily goal log. 
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Visit www.crouse.org/21daychallenge for more challenge details and to see other success stories.

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* 1. Please enter your information.

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* 2. Organization:

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* 3. What was your 21 Day Challenge Start Date?

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* 4. What was your 21 Day Challenge End Date?

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* 5. What was your 21 Day Challenge Daily Goal?

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* 6. Did you meet your daily goal? 
Raffle winners will be asked to produce the daily goal log.

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* 7. Do you think you will continue this habit?

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* 8. Do you allow Simply Well to include your name and goal on the Crouse Website, with the "21 Day Finishers" List?

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* 9. Please provide any additional comments about your experience with the 21 Day Challenge:

Thank you for participating! 

Successful participants will have their name entered into the monthly raffle drawing.
 
You can do multiple 21 Day Challenges during the year.  Earn an additional raffle entry for each “21 Day Challenge” you complete.
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