Registration Form

Please complete this form to register for the 2019 challenge. You will receive an email at the address you enter below with further instructions for reporting your weekly activity. You must participate in at least four of the weekly challenges to be eligible for the grand prize. Please see the challenge website for full details and eligibility rules. 

Question Title

* 1. What is your first name?

Question Title

* 2. What is your middle initial?

Question Title

* 3. What is your last name?

Question Title

* 4. Email address you'd like to receive challenge updates & newsletters?

Question Title

* 5. What is your age?

Question Title

* 6. I am:

Question Title

* 7. How did you hear about this year's Community Health Challenge?

T