Join 10Day Weight Loss Marathon

1

How much Weight would you like to lose ?* This field is required.mention kg you would like to lose

2

Give me 3 reasons why you want to lose / gain the weight NOW !You won’t lose it all in the first 10 days but that’s why we call it a Marathon, and you can do as many “laps” 1 lap = 10 days , as you need to reach your goal.

Reason 1

Reason 2

Reason 3

3

What program / Products have you tried before ?* This field is required.Shape Up Programs / diets / you have used in the past 60 days for Shape Up

4

In the Past - Did you have a Coach that supported you on your Weight Loss /Shape Up Journey ?* This field is required. Choose 1 option

YESNO

5

**NEW** 10 Day Weight Loss Marathon

EXAMPLE OF A DAY for 10 Days = 1 lap

Can you do this?
1️⃣ Morning: Meal replacement shakes and Fat burner Drink for Breakfast (100's of recipes)
2️⃣ Mid morning : Protein Snack from our Snack list
3️⃣ Afternoon: Meal replacement shakes for Lunch and fat burner Drink
4️⃣ Mid afternoon : Protein Snack from our list
5️⃣ Evening : Healthy dinner of your choice from our list

If you answered YES - Lets's Go

6

My Name* This field is required. Your Name & Surname

7

My Contact WhatsApp Number* This field is required.Your Best WhatsApp Number

8

My Best Email Address* This field is required. To receive your Confirmation and Info

9

How did you hear about the 10-day Marathon? * This field is required.

Engela / Stef's WhatsApp / Facebbok / Instagram Stories / Status

Engela / Stef's approached me Personally

A Friend told me about it

Can't remember

10

If you answered 'A friend' above, please let me have their contact details, so that I may thank them below

11

If 3 of your friends join you on the 10-Day Marathon, YOU get an extra FREE energy/fat burning tea for ACCELERATED centimetre loss when purchasing any combo. Will you be doing the Marathon with a friend? * This field is required.

YESMAYBE LATER

12

My Friend #1 Name

First Name

Last Name

13

My Friend #1 WhatsApp Number

Please enter a valid phone number.

14

My Friend #2 Name

First Name

Last Name

15

My Friend #2 WhatsApp Number

Please enter a valid phone number.

16

My Friend #3 Name

First Name

Last Name

17

My Friend #3 WhatsApp Number

Please enter a valid phone number.

18

Thanks for completing my form. I look forward to discussing and Welcoming you (and your friends) being on my Next 10Day Weight Loss Marathon team and will be in contact with you shortly via WhatsApp.

REMEMBER TO FILL IN YOUR DETAILS

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