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3 Free Months of Weight Watchers + $75 Gift Card for in-person, $50 gift card for virtual

Fill out the form below if you are available to attend
5 Free Weight Watchers Sessions, 1 per week

Starting: Wednesday September 1st, 10am
Location: 319 Franklin Ave Suite 111, Wyckoff, NJ 07481

OR

Starting: Friday August 27th, 2pm EST
Location: Virtual

2021-Jul Weight Watchers
Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Gender
Are you currently Pregnant, trying to become Pregnant or Breastfeeding?
Have you lost more than 10lbs in the last 3 months?
Do you want to lose at least 11 or more pounds?
Do you currently suffer from any of the following?

Height & Weight

Do you agree to answer weekly surveys?
Are you currently following any weight-loss plans or diets?
Have you ever followed a Weight Watchers plan before?
Are you open to following a Weight Watchers Plan?
Do you have access to an iPhone using iOs 12.0 or Higher?
What is your Household Income?
What is your Highest level of Education?
Do you have access to a scale?
Do you agree to attend a weekly 30-40 minute in-person (for Staten Island and SF) or online (for Virtual Workshops) weight-loss group workshop lead by a WW Coach?
Do you agree to sign an NDA (Nondisclosure Agreement)