DEX-L10 Clinical Studies

PERSONAL INFORMATION

* Denotes a required item
Last Name:
*
State:
*

*
 
Fax:

Gender:
Male Female *
Personal Website or Blog:

 

LIFESTYLE

Height:
ft.*  in.*
 
Have You Ever Competed in a Fitness Competition?:
If So, What Year?
Why Do You Want to Get in the Best Shape of Your Life? *
Will work, school or other activities/duties in any way interfere with your ability to complete the exercise portion of your transformation (i.e. 1.5 hours/day of cardio and weight training 4 times a week for 30 minutes)?*
Yes
No

What is the longest period of time you have been on a diet in the past?*
less than a month
1 - 3 months
3 - 6 months
over 6 months

You will be eating 6 meals per day spaced every 2½ – 3 hours. Do you feel that you will be able to do this consistently with work/school and any other commitments you have?*



Where did you hear about this?*




 If other, please Specify:
Your personal information will never be disclosed to any third-party mailing list without your consent.

Privacy Statement    |    Terms of Use

 
Only qualified applicants will be contacted.





DEX-L10 is available at