This form is for the people who are taking the One Per Month Challenge

Please submit your information so that we can see how the program is working for everyone.
Thank you so much for submitting your information to add to this data, it really does help!
Please be sure to email this link to yourself and take the survey each month!

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* 1. First Name:

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* 2. Last Name Initial

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* 3. City, State

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* 6. What is your weight for the above month?

0 800
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i We adjusted the number you entered based on the slider’s scale.

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* 7. What was your weight the month before?

0 800
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i We adjusted the number you entered based on the slider’s scale.

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* 9. Email address (we'll send a monthly reminder to do next month's survey if you're willing to be part of this 12 month study)

T