Pre-ProportionFit Survey and Weight-Loss Challenge Registration

Registration for weight-loss challenge

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* 1. Why are you following The ProportionFit Diet & Health Plan (choose up to three answers)?

Improved health

Improved appearance

Improved sleep

Improved activity tolerance (ability to exercise, perform physical tasks,etc.)

Peer pressure (direct or indirect)

Other (please specify)

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* 2. What techniques have you tried (if any) in the past to lose weight (choose as many as apply)?

High protein, low carb (Zone, Atkins, etc.)

Paleo

Meal system or plan (Jenny Craig, Medifast, Weight Watchers, Seattle Sutton, Nutrisystem, etc.)

Cut out breads/grains

Cleanses

Vegetarian Diet

Exercise programs

Other (please specify)

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* 3. What has been the biggest challenge to lose weight in the past (Choose all that apply)?

Cost/Expense

Difficult to follow/Too complicated

Good for short term, but difficult in long term

Good for long term, but difficult in short term

Self-motivation to "stick with it"

Attempts in past just ineffective

Often hungry

Temptations all around me

Lack of support from others around me

Other (please specify)

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* 4. Which ProportionFit product did you purchase?

Only the book (The ProportionFit Diet & Health Plan)

Weight Optimization Kit (Book, Portion Kit containers, food models, collapsible container, tape measure, body fat caliper, reminder bands, instructions)

Exercise Kit (Jump Rope and Resistance Bands with Weight Optimization Kit)

Fitness Kit (Fitness Tracker with Weight Optimization Kit)

Total Health Kit (Fitness Tracker, Jump Rope, and Resistance Bands with Weight Optimization Kit)

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* 5. What is your gender?

Female

Male

Prefer not to answer

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* 6. What is your age?

Years

110

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 7. What is your most recent measured weight (in pounds)?

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* 8. What is your current waist circumference (optional)?

inches

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 9. How many push-ups can you complete without stopping (optional)?

Push-ups

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. How many "chair squats" can you do in 60 seconds (optional)?

Chair squats

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 11. If you win prize money from the challenge, who gets the money (prizes will vary based on placement and number of participants; donations to charity will be made with acknowledgement that you directed the money to that charity)? Note: You can change your mind later....

United Heroes League

Twin Cities Orthopedic Foundation

United Way

Healing Haiti

Feed My Starving Children

ME! I want the money.

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* 12. What is your name and email address (used for tracking purposes only and will not be shared)?

Name

Email Address

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* 13. In order to qualify for prize money, you will need the following (pictures need not be shared unless you win):
1) A picture showing your starting weight, and another showing your final weight, while you are on the scale
2) A "before" picture of you (ideally a frontal and side view, dressed appropriately for public sharing)
3) An "after" picture at the end of the challenge (similar to above, only better!)
4) A social media posting (posted within a week of starting the challenge and again at the end of the challenge) on Facebook, Twitter, or Instagram sharing that you are starting, and then finishing, the challenge with #IAMProportionFit somewhere in the post.
5) At the end of the challenge, you will need to share the above pictures with ProportionFit to confirm validity and also for promotional purposes in order to receive the prize money for yourself or charity, should you qualify.

Yes, I have done these things or will do these things as required

No, I do not want to do those things

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* 14. I would like to register for the following challenge (may choose more than one):

2 month

6 month

1 year

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* 15. Do you certify that you will follow the principles of ProportionFit for the weight loss challenge (as described in The ProportionFit Diet & Health Plan) and the answers provided here are accurate to the best of your ability?

Yes