Bakersfields Biggest Loser
Registration
Your Name
First Name
Last Name
Email
*
example@example.com
Please confirm your cell
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Birth Date
*
-
Month
-
Day
Year
Date
Date
*
-
Month
-
Day
Year
Date
Genter
*
Male
Female
Your current weight
*
Body Fat%
*
Where did you weigh in
*
Warrior 1 Yoga
Envista Medical
Osteostrong Bakersfield
eupepwell
Upload at least 5 photos (4 of you as shown above and the weigh in form)
*
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