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.
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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