4 B
SIUSLAW NEWS ❚ WEDNESDAY, JANUARY 27, 2016
First Weigh-In Jan. 27 (mandatory!)
th
7am-9am and 4pm-6pm
N
!
E
I
S
O
W
L to
It’s BACK...
BE
FLORENCE’S
BIGGEST
WEIGHT PERCENTAGE
LOSER
LOSE-TO-WIN
CONTEST!
Over $1700 in Prizes & Gifts!
FREE ENROLLMENT
14-Week Contest
January 27-May 4, 2016
– Only your weight loss average will be published. –
• Weigh in each week at COASTAL FITNESS & AQUATICS
• Each Wednesday, Jan. 27 - May 4, 2010 • 7am-9am and 4pm-6pm
• Weekly leaders in each category (male & female) will be pictured in
the Saturday edition of the Siuslaw News.
• Learn Healthy Weight Loss Steps
• Look Good - Feel Good
Contest Information Line:
541-997-3441
FREE CONTEST PARTICIPATION • REGISTRATION FORM
Weigh-In Location:
Coastal Fitness &
Aquatics
Please complete and bring or mail this form to the Siuslaw News,
P.O. Box 10, Florence, OR 97439
Registration is FREE. Contestants must
be a minimum of 18 years old or with
parental consent and sign a waiver
form to participate.
Name: _________________________________________
Your registration form must be
received at the Siuslaw News,
by 5pm January 25th.
148 Maple Street,
Mail: PO Box 10, Florence, OR 97439
Fax: 541-997-7979
or via our website
www.thesiuslawnews.com
______________________________________________
Address: _______________________________________
Phone: _________________________________________
Email: _________________________________________
Are you a subscriber of the Siuslaw News?
YES
NO
OFFICE USE ONLY
Face Photo #__________ Full Portrait Photo # _________ Disclaimer Signed
YES
NO
Sponsored by
Siuslaw News
148 Maple St., Florence
541-997-3441
2285 Hwy. 101, Florence
541-997-8086