Please use the form below to register your team for LiveWell Frederick's  Healthy Habits Reset Challenge.

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* Business/Organization Name

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* Team Leader Name (that's you!)

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* Team Leader Email

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* Team Name (don't forget to share this with the rest of your team!)

Please list the first and last names of your team members below, along with their email addresses. You may have up to 5 people on your team, not including the team leader.

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* Team Member 1

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* Team Member 2

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* Team Member 3

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* Team Member 4

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* Team Member 5

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