Individual or Solo Participation
All fields are required except weight and comments box.
Name
Sponsor?
Address
City
State
 Zip
Telephone
Email
Male
 Female
Age Division
Men sizes, XXX, XX, XLG, LG, MED, SM.
100% cotton, heavyweight white.
T-Shirt Size
* Weight
Optional
Attend June 14 kickoff?
 Yes
 No
* Comments or
questions?
* Optional
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Reset the form and try again filling in all fields
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
* Participation in the weight
loss program is OPTIONAL. By
filling in the weight box above
indicates participation.
Weigh-in prior to each check in
date. Weight loss points will be
added into and posted along
with the miles/points charts.
QUESTIONS?
Contact Dennis Ketterman
Alternatives Magazine
P.O. Box 493
Plentywood, MT 59254
406-765-1401
Email: dennisk@nemont.net
PAY?
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.