Team Participation
All fields are required except weight and comments box.
Team Name
Sponsor?
Age Division
Average age of team
determines division. See chart
 Total Team
Weight
* Optional
_______________________________________________________
Team Captain
Address
City
State
 Zip
Telephone
Email
T-Shirt Size
_______________________________________________________
Teammate #2
Email
T-Shirt Size
Teammate #3
Email
T-Shirt Size
* Comments or
Questions?
* Optional
AGE and GENDER DIVISIONS
For teams, average age of
teammates determines division.
    Division 1: 10 - 15
    Division 2: 16 - 20
    Division 3: 21 - 25
    Division 4: 26 - 30
    Division 5: 31 - 35
    Division 6: 36 - 40
    Division 7: 41 - 45
    Division 8: 46 - 55
    Division 9: 56 - 65
    Division 10:  66+
Pounds Lost
 Points
10 - 20
 5
21 - 30
 10
31 - 40
 15
41 - 50
 20
51 - 60
 25
61 - 70
 30
71 - 80
 35
81 - 90
 40
91 - 100
 45
100 +
 50
Weight Loss Points
Alternatives Magazine
P.O. Box 493
Plentywood, MT 59254
406-765-1401
Email: dennisk@nemont.net
QUESTIONS?
Dennis Ketterman 406-765-1401
* Participation in the weight loss program is OPTIONAL. By filling in the Combined Team Weight box above indicates
participation. Teams must weigh in prior to each check in date to provide a progress report which will be posted along
with the miles/points charts.  Individual weight of teammates is not required.

You may pay by check or by credit card.
By check:
Payable to Mountain Publishing
P.O. Box 493
Plentywood, MT 59254.

By credit card:
Click on the Pay Now button below and follow the instructions.