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14-day Healthy Eating Challenge Application
Welcome! Please apply to be considered for the free 14-day Healthy Eating Challenge.
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* Indicates required question
Name
*
Your answer
Email address
*
Your answer
Phone number
Your answer
Why are you interested in joining the 14-Day Healthy Eating Challenge?
*
Your answer
Do you currently exercise regularly?
*
Yes- 5-6 times/week
Yes, 1-3 times/week
I used to, but not anymore
I've never worked out before
Other:
Your answer
What do you see as your biggest weakness when it comes to healthier eating?
*
Your answer
Do you have any dietary restrictions I should be aware of? (gluten, nut allergy, lactose intolerance, vegeterian?)
Your answer
Answer these questions honestly:
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
n/a
I am willing to consciously work for 14 days on healthier eating skills.
I am committed to checking into a Facebook group daily and/or having a one-on-one phone consultation with Amanda.
I am willing to dedicate time to preparing my meals and being open to new things!
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
n/a
I am willing to consciously work for 14 days on healthier eating skills.
I am committed to checking into a Facebook group daily and/or having a one-on-one phone consultation with Amanda.
I am willing to dedicate time to preparing my meals and being open to new things!
Lastly, is there anything else I should know? Answer below!
Your answer
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