Have you reached your weight loss goal or are you getting close?
Share your success story!

Lipozene users age 21 and up, who ...

- Have acheived weight loss goal or are close to it
- Have lost at least 20 pounds
- Are able to provide before and after photos
- Willing to participate in national commercial shoot

* First Name:
* Last Name:
* Address:
  Address 2:
* City:
* State:
* Zip:
* Phone:    
* Email Address:
* Number of Pounds Lost:
* Enter the words:

By submitting photos through this page, you warranty that:
1) The photos submitted are owned by you, and that no other person can claim IP (copyright) rights in them.
2) You grant this website and company an irrevocable, non-exclusive, royalty-free license and right to use these photos in connection with the marketing and advertisement of our weight loss supplements.
3) You understand that the purpose of this submission is to provide actual pictures of your results using our products, and warranty that these photos are representative of those results.