Mamavation Campaign Application

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Full Name *

Vlog Application URL *

Twitter URL *

Website *

Email *

Phone Number *

Personal Facebook page link *

Skype (don't worry if you don't have one yet)

Address *

City, State, Zip *

Age/Birthdate *

Are you married? *

How many children do you have? Ages? *

Weight *

as measured in lbs - numbers only

Height *

as measured in feet'inches = ex: 5'7

BMI *

BMI calculations can be found here: http://www.nhlbisupport.com/bmi/

Clothing size *

Do you have any medical conditions? If so, please explain. *

Do you have any psychological conditions or suffer from depression? Are you being seen by a specialist for them? Please explain. *

Are you on ANY medication? If so, please explain. *

Do you have any food allergies? If so, please name them.

Have you spoken with your family about your application and are they supportive? Please explain. *

Are you breastfeeding? *

This does NOT disqualify you from the campaign.

Yes

Are you willing to sign a legally binding contract and non-disclousure form for the campaign? *

Do you agree to NOT hold Bookieboo LLC liabale for ANY injuries resulting from the Mamavation campaign? *

Submit

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