“Change Your Story” Challenge!

Contact Information & Background

• Name*
  
• Email*
  
• Home Address
  
• Phone
  
• Age
  
• Occupation
  
• Height
  
• Current weight
  
• Goal Weight
  
• Current size (Dress/Pants)
  
• Before Photo
  
• After Photo
  
• Are you currently taking any medication for diabetes, high blood pressure, high cholesterol, etc.? Please describe:
  
• Please tell us about your social media activity. Do you use Facebook, Twitter, Instagram, etc.). If you blog, please provide a link
  

Why do you want to participate in the Lean for Life® “CHANGE YOUR STORY” CHALLENGE?

Please take a few minutes to tell us about yourself by answering the following questions.

Part 1

• How does being overweight impact your life?
• How do you feel about your body?
• How long has weight been an issue for you?

Part 2

• Was there an ”aha moment” when you decided to begin your journey to a healthier life?
• What would it mean to you to be lose weight, improve your health, and become Lean for Life?
• What has been your experience with other weight loss programs?

Part 3

• How do you feel about sharing your story with the media, online, and in advertising?
• What is your greatest motivation for losing weight?
• What do you most look forward to doing when you are Lean for Life?

Details

• Ten (10) contest entrants will be selected to participate in the Lean for Life by Lindora Clinic® "CHANGE YOUR STORY" CHALLENGE.
• Selected Southern California residents will participate in the clinic program at one of our 39 Lean for Life by Lindora Clinic locations
• Selected entrants who live outside Southern California will participate by using our Lean for Life Online program.
• All selected participants in the Challenge will receive their programs free of charge. All participants agree to participate in an event announcing the winner on DATE in Los Angeles.