Start Form
Staying Alive in 2005 Official Start FormTake this form with you when you get weighed in at the Mall of America, Gold's Gym, or by a physician or a nurse. Fill in all the fields. Keep this form until you get further direction from the show or on drphil.com. This is your OFFICIAL entry form, and you will need it in order to bump someone out of the Challenge.Challenger's Name: ___________________________________________________ Date: _________________________ Height: ____________ Weight: ____________ Percentage of Body Fat or BMI Index (if available): ____________ Goal Weight: ____________ Official's Signature and Printed Name: ____________________________________ Official's Title: ______________________________________________________ Phone Number: _________________________________ |