Exante Transformations US

We love seeing your transformations, so much that for every ‘before’ and ‘after’ photos we're giving you the change to WIN our monthly transformation prize of your choice; either $100 CASH or $150 Health & Beauty vouchers!*

What's more, you could also be in for the chance to WIN our annual weight-loss challenge transformation prize of a holiday!*

Simply fill in the survey below, uploading both your ‘before’ and ‘after’ transformation pictures*.

*Transformation prizes will be judged based on transformation submissions uploaded between the first day and last day of each calendar month, starting 01/01/2017 - 31/01/2017, based on qualifying with our T&C’s*.

1. Personal Details *This question is required.

First Name

Last Name

Title

Age

Address Line 1 (Street Address, P.O. Box, Company Name)

Address Line 2 (Apartment, Suite, Unit, Building, Floor)

City

State/Province/Region

ZIP

Country

Email Address

Phone Number

Occupation

2. What made you decide to lose weight? (please give as much detail as possible) *This question is required.

3. Measurements *This question is required.

My start weight was...
My current weight is...
My goal weight is...(if different from current weight)

4. Clothing Size *This question is required.

My start clothing size is...
My current clothing size is...
My goal clothing size is...(if different from current)

5. What are your top 3 favorite Exante products?

1
2
3

6. What have you learnt during your weight-loss journey with Exante? *This question is required.

7. How did your plan fit into your lifestyle?* (Please state whether or not you followed one of our recommended diet plans - if not, what did you do?) *This question is required.

8. When did you first notice a difference?* (this can relate to weight-loss,size, (non-)physical, life differences when using Exante products) *This question is required.

9. How has your life changed since losing weight? Tell us your story and inspire others.* *This question is required.

10. What is your next goal (weight related or life related)? *This question is required.

11. Upload your Transformation Before picture

To support your transformation story we will need at least 2 photographs, a "before" and "after". If you do not have a "before" try reflecting the size change through an old piece of clothing.* *This question is required.

File: {{filename}} delete

12. Please upload your Transformation ‘After’ picture* *This question is required.

File: {{filename}} delete

13. Please give us your digital signature to comply with our transformations T&Cs*.

*By returning this form and signing below I hereby irrevocably authorise The Hut.com Limited (trading as Exante Diet) ("Company") and its affiliates to copyright, publish, reproduce, exhibit, transmit, broadcast (including on the Exante website and Social Media), televise, digitise, display, otherwise use, and permit others to use, (a) my name, image, likeness, and voice and (b) all photographs, recording, videotapes, audio-visual materials, writings, statements, and quotations of or by myself (collectively, the "Materials"), in any manner, form, or format whatsoever now or hereinafter created, including on the Internet, and for any purpose as chosen above, including, but not limited to, advertising or promotion of the company, the Exante website and/or the Exante Products, without further consent from or payment to me. * *This question is required.

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