Final Step!
Fill Out Your Application
Full Name
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First
Last
Phone
*
In case you win
What town do you live in?
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Age
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Height
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Feet | Inches
Weight
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Best guess or approximate
How Much Weight (if any) would you like to loose?
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How much Time and Money have you spent trying to reach your goals?
*
How does that make you feel?
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Since we are offering this program for free and only to four individuals, why should we choose you?
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On a scale of 1-10, how do you feel about your body right now?
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(Number 5 - I’m fine, but don’t like seeing pics of myself) (Number 10 - I look GREAT)
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5
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10
On a scale of 1-10, what are your energy levels like right now?
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(Number 1- I can’t get out of bed) (Number 10 - I have great energy)
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10
What made you fill out this form today?
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Please be as detailed as possible
What have you tried in the past? What worked? What didn’t work?
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Finally, which one describes you best?
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Excuse maker that always looking for a magic pill?
Procrastinator that always put things off.
An action taker that wants to make a change NOW!
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