2022/2023 BWell Health Challenge Registration

This Challenge will run from September 12, 2022 to April 3rd 2023.

Name Name * First Last
Email *
Will you be attending the Kick-Off Luncheon on September 12th at noon? *

Will you be attending the Kick-Off Luncheon on September 12th at noon? Yes No Click for vegetarian option
If you are attending the Kick-Off Luncheon, which campus will you be attending at?

If you are attending the Kick-Off Luncheon, which campus will you be attending at? Brockport Campus Rochester Campus
Interested in 50% off SERC Membership?

Interested in 50% off SERC Membership? Yes No
Which campus will you be weighing in at?

Which campus will you be weighing in at? Brockport REOC
Please affirm the following: *

Please affirm the following: I have voluntarily applied to participate in the 2022/2023 BWell Health Challenge. I agree to practice healthy nutrition and exercise methods while partipciating in the 2022/2023 BWell Health Challenge.
Your signature affirms the above statements. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

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