Independent Distributor Of Herbalife Products.        33108575       (INDEX)
 
 
 

Welcome to our site ! Please be sure to fill out the form below completely. Once your form has been submitted You will be provided with all the details of our proven weight control program suitable for You. Your data will be used only in order to meet your request.

  
         

A FORM
  E-mail:  

 
  Your Name:  

 
  Address:    
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  Country:  

 
  Phone (international):  

 
  Fax (international):  

 
  Blood group:  

 
  Age:  

 
         
 I'm often hungry.
 I like candy's.
 I eat a little.
 I eat because I want to be in a good mood.

What and when I eat usually:
         
  First meal:  

 
  Breakfast:  

 
  Morning snack's  

 
  Lunch  

 
  Afternoon snack's:  

 
  Dinner  

 
  Supper or snack's:  

 
         
Coffee - (daily cups of coffee),
Tea -   (daily cups of tea),
Water - (glasses daily),
Milk - (glassesdaily).

  
  Drinks:  

 
  Alcohol:  

 
  Cigarettes:  

 
  Health problems:  

 
  Did You exercise ?  

 
  Did You use another diet in the past ?  

 
 
I've got and I want pounds.
 

Comments or questions:
 

 

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