MOTIvate 2021 Registration Form 1 Personal Info2 Goals Name*Age*Gender*GenderMaleFemaleTransgenderWould rather not sayKnown Diseases (if any)Mobile Number (Username)*WhatsApp number preferredLocationEmail (optional) Facebook ID (optional)Instagram Handle (Optional) You want to be an INSPIRER¹ and pledge to lose weight for a better health?*YesNoYou want to be a MOTIVATOR² and share your Health & Fitness journey with the INSPIRERS who want a better health?*YesNoYour Current Photo*Please upload your current photo for us to analyze your health improvement progress later when you complete your pledge. (Max size 1MB)Accepted file types: jpg, png, jpeg.Present Body Weight*KgI pledge to be an INSPIRER and lose*Please enter a value greater than or equal to 3. Kgs in 2021Referrer/Inspirer Mobile (Registered)Participant Consent*Your consent is required to participate in the contest. Please read carefully the campaign terms & conditions before you agree and take participation. I Agree to the terms of the campaign ¹Inspirer: Eager to Lose Weight Tribe ²Motivator: Fitness, Weight Management Experts & Hit-Fit TribeEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
