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Before/After Form Submission

This form is used to submit before and after progress
  • Please give a formal statement about your experience with this program and your journey to a healthier life.
    I understand that I am giving my consent to VITAstir and its affiliated companies to share my submission to other contestants. I agree to the use without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to VITAstir, its affiliates and agents, to use my image and likeness and/or any statements from me in its publications, advertising or other media activities. This consent includes, but is not limited to statements, photographs and basic name and demographic information. (a) Permission to statements made, photographs, tape, or otherwise make a video reproduction of me and/or recor (b) Permission to use my name; and (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and motivational purposes.