EmailMeForm
25 Day Weight Loss Challenge
Complete form for enrollment in the 2025 Weight Loss Challenge
Program Director: Julie Day
May 1-25, 2025
Name
First
Last
Date of Birth
Email
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Phone
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Build Your Own Smoothie Cleanse
*Select 8 smoothies for pickup on Tuesday, May 6th
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Clean Green with protein
Berrylicious with peanut butter
Wedding Cake with spinach
Strawberries N Cream with collagen
Jumpy Monkey with protein and spinach
Up Beet with protein
Refresh with flax
Reverse (includes protein and spinach)
Power Smoothie with protein
Vanilla Fuel Up with spinach
Milky Whey with flax
Beach Breeze with protein
Super C with collagen
Mango Medley with protein
Funky Monkey with protein and spinach
*Must select 8 smoothie options
Please list any food allergies:
What time can you stop by for your weigh-in on Thursday, May 1st? (10 mins)
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What time can you stop by for weigh out on May 25th? (10 mins)
*
T-Shirt Size for FREE T-Shirt
Credit Card
Members: $125
Non-Members: $199
*Includes 25 day membership
Card Number
Expiration
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Liability Waiver:
I understand that I (Including me and/or my children) risk injury and even death if I participate in aerobic and other exercise programs which involve using any and/or all of the services, equipment, machinery and facilities at Spoga Inc. if :
1. A medical doctor has not first determined that I am physically fit to participate: and
2. I participate in exercise/fitness activities or use equipment and /or facilities without first being
instructed by Spoga staff in the correct way to participate in the activities or use of the equipment.
I realize that I, not Spoga Inc., am responsible for having my own health evaluated before I participate in any exercise program, and for receiving instruction from Spoga’s staff before using any of the services, equipment or facilities. Unless, I notify Spoga in writing to the contrary, I understand and agree that Spoga is entitled to assume my physician has approved for my own participation in the exercise/fitness activities I participate in, and that I have received instruction form Spoga staff on the correct way to use any service, equipment and/or facility at Spoga Inc.
With the full knowledge of the risks involved in participating in aerobic and/or exercise programs and using Spoga’s services, equipment and/or facilities, and in consideration of my membership at Spoga, I release Spoga Inc., its members, employees and agents, from any responsibility for damages losses or injuries I suffer while participating in any aerobic and/or exercise program, or using any equipment and/or facility at Spoga Inc. I also agree to defend any claim or lawsuit, pay all attorney’s fees and costs, indemnify and hold harmless Spoga Inc. , its members, employees, and agents from any and all liability, claims and/or demand for damages, injuries, death, losses, costs, or expenses of any kind resulting from or which are claimed to have resulted from anyone admitted to Spoga as my guest or my own participation in any aerobic and/or exercise program or use of any equipment and/or facility of Spoga Inc.
I understand that all spa services vary in result based on the individual. I acknowledge that there are potentially dangerous conditions that are present when receiving spa treatments. I also understand that Spoga, Inc. is not responsible for any allergic reaction you may encounter from stylists and/or The Power Bar products.
I acknowledge receiving, and reading, and do understand the agreements contained herein, including the release of liability and hold harmless obligations.
I authorize Spoga Inc. to verify the information contained in this membership application and agreement.
Please sign below:
Signature
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**25 Day Weight Loss Challenge will charge to card on file upon submission and will receive an email receipt.
$1.00 will not be charged to card on file listed below.
Total
$1.00