Submission Date*
Team Name / Organization Name / Business Name*
Team Leader Name*
Team Leader Number of Steps/Activity Seconds (Last Monday Thru Last Sunday)*
Team Leader Email*
Zip Code*
Team Member #2 Name
Team Member #2 Steps/Activity
Team Member #3 Name
Team Member #3 Steps/Activity
Team Member #4 Name
Team Member #4 Steps/Activity
Team Member #5 Name
Team Member #5 Steps/Activity
Team Member #6 Name
Team Member #6 Steps/Activity
Team Member #7 Name
Team Member #7 Steps/Activity
Team Member #8 Name
Team Member #8 Steps/Activity
Team Member #9 Name
Team Member #9 Steps/Activity
Team Member #10 Name
Team Member #10 Steps/Activity
If this is your first time participating in this challenge, who referred you?
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