Just 21 Days

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Hi!

This is where you sign-up to take a small, but healthy step in the right direction. We aren't asking you, with your busy lifestyle, to tackle everything all at once. We hope, after you have some success with a small step, that you will continue to build on your new healthy habit and change your lifestyle into the most beneficial one for you.

Enter your information below. Once you set up your account you can use your screen name (an alias) to chat with others on their journey, track your progress, write a journal and print reminders or make screen savers to help you along.

Each time you come back to the site, log on with your screen name and password to reach the member menu.

And be sure to tell us about your success! We may feature you on this Website and elsewhere!

Screen Name:	(required) NOTE: Screen name must contain only alpha-numeric characters and no spaces. They are unique to each user.
Password:	(required)
Confirm Password:	(required)
First Name:	(required)
Last Name:	(required)
Address:
Address 2:
City:
State:
Zip:
E-mail:	(required)
Gender:	Male Female
Age Range:	18-25 26-39 40-60 61-70 71 or over
Please select one of the following habits to work on for 21 days: (required)
	1. Stop the soda pop; choose water instead. 2. Reduce the number of cigarettes you smoke each day by one less cigarette. 3. Eat at least five servings of fruit and/or vegetables per day. 4. No high calorie fast food (i.e. hamburgers, fries, shakes, etc.). 5. Downsize your portions. 6. Start gradually, but make at least half of your grains (carbohydrates), whole. 7. Consume only fat-free or low-fat dairy products. 8. Walk, or exercise, for 30 minutes each day. 9. Eat breakfast every day.
Please select date you would like to begin: (required)
	/ / 2007