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21Day Shape Up Challenge - Information Request
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Name
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First Name
Last Name
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2
WhatsApp Number
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3
E-mail
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4
I am interested in:
Choose all relevant
21Day Challenge
Weight loss / Belly Fat
Healthy lifestyle
Weight / Muscle gain
Other
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5
Have you used Herbalife products before ?
*
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No, this will be my first time
Yes,
I am a member / Distributor at 25% to 50%
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6
What is your budget?
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R600 - R850
R850 - R1,200
R1,200
2000 +
Other
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7
choose your Starting date
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Date
Year
Month
Day
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8
I would also be interested in
Use Products as a Customer Only on Full Retail Price - Do Not want Discount
Joining the Loyalty VIP Program (discount option starting 15% - 35% )
Part time income
Other
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