VWC Biggest Loser Competition
Contestant Application
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Branch in the Military (i.e. Army, Navy, Marine, Air Force)
Current Weight
Goal Weight
Why are you interested in entering this competiton?
Are you able to commit to 3 treatments a week between the hours of 8am - 12pm at our location at 5911 Monticello Drive, Montgomery, AL 36117 from April 1st to April 29th?
Yes
No
How did you hear about this competition?
Submit
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