SKINNY JEANS CLUB - Get Skinny in Oregon

SERIOUS Weight Management Program for
SERIOUS People who want to achieve
SERIOUS Weight Loss Results
Only, If YOU are SERIOUS...
Join Today!

Fill out form below & submit. You will be contacted by your nutritional advisor with instructions on where to begin.

Register Here
Your nutritional advisor will contact you shortly with the number for the INTRODUCTION TO SKINNYJEANS conference call. If you desire a personal consultation, one will be available to you at your request. All services are provided FREE OF CHARGE, Cost of products will be at participants expense. Cost depends of choice of system 1, 2 or 3. Products carry 100% HASSLE FREE satisfaction guarantee. All details will be given on introduction phone call. YOUR INFORMATION WILL BE KEPT CONFIDENTIAL AND NEVER SOLD OR USED FOR ANY OTHER PURPOSE.

Contact Information

First & Last Name:	*
Address Street 1:
City:	* *(5 digits)
Daytime Phone:	*
Evening Phone:
Best time to call::
Email:
How did your hear about us?:	*(required)
Flyer Code::

Health & Fitness Goals (check all that apply)

Lose Weight	Improve Blood Pressure	Increase Muscle / Bone Strength
Look Better	Improve Physical Condition	Sleep Better
Feel Better	Improve Cholesterol Status	Reduce Dress or Pant size
Increase Energy	Reduce Stress	Live Longer

Do you eat breakfast? yes no	What is your current size?
Do you take vitamins? yes no	How much weight would you like to lose?
What do you drink other than water?
How long have you been wanting to lose weight?
When would you like to start a program to reach your goals?
Do you currently exercise? How often?

Comments or Feedback

ARE YOU SERIOUS ABOUT REACHING YOUR HEALTH & FITNESS GOALS?
YES NO

OREGON SKINNY JEANS CLUB
Tigard / Forest Grove / Eugene & Surrounding Areas
President - Toni Vitacco
(971) 219-8705
tigardOR@skinnyjeansclub.com
www.healthandhope4u.com

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