Lose to Win 2023

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Are you a Marcrom's Pharmacy Employee?

Yes

No

If you are registering for multiple people please a different email address for each person. Thanks! *

I understand and I will!

Email Address *

Confirm Email: *

Current Occupation? *

Date of Birth? (MM/DD/YYYY) * +

Height

Feet *

Inches *

Program Level

Level One - $90

Includes:

Membership for all of 2023
Access to Facebook Group
Any meetups or challenges we MAY do
Access to monthly Zoom meetings
Access to previous Lose to Win educational videos with healthy lifestyle/weight loss tips, techniques, and other information

Level Two - $150

Includes:

EVERYTHING in Level One
2 Body image scans ($60 value)
2 cholesterol checks ($60 value)
Free blood pressure checks ($25 value)
Saturday weigh ins (invaluable!)

Level Three - $239

Includes:

EVERYTHING in Level One
EVERYTHING in Level Two
2 one on one sessions with Joe to help create a plan for your journey
At home weigh-in option

Which month are you starting? *

Please do NOT continue.

We do NOT have the price loaded for your starting month yet.

Please come back around the 21st of the month prior to the month you wish to start.

Which level are you enrolling in? (Select THIS option for a April 1 start date) *

Level One ($90)

Level Two ($150)

Level Three ($239)

Which level are you enrolling in? *

Level One ($00)

Level Two ($00)

Level Three ($49)

Would you like to customize your program? *

Yes ($39)

No

Please describe your thoughts on how you would like to customize your program: *

Did you watch the video explaining this year's program? *

Yes - I did!!

No I did not

I understand that the program this year is significantly different than in year's past. Even though I didn't watch the video I still want to join. *

I agree