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Lose it and Gain Pledge Form
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* Indicates required question
Name
*
Full name, please!
Your answer
Email Address
*
We may need to follow-up on your pledge!
Your answer
Who are you pledging money for?
*
Here you name the person participating in our weight loss challenge
Your answer
What type of pledge are you making?
*
Per Pound
Flat donation
Required
How much are you donating?
*
Here you share your amount you will donate (per pound or flat donation) for the participant named above
Your answer
How will you make payment?
All payments are due by April 13th
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Paypal
Check (made out to FGP and given to participant or sent to 43 Town and Country Drive S119 PMB 102 Fredericksburg, VA
Other
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