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Be in the running to win $1,000 cash! It′s easy!

Simply fill out this entry form and tell us in 20 – 100 words how losing your weight has changed your life. Please see Terms and Conditions for more details.

Entry Form

Please complete all required fields marked with *.

Please note photos are encouraged but not essential with your entry.

* Required Fields

* First Name:

* Last Name:

* Gender:

MaleFemale

* Address 1:

Address 2:

* Suburb:

* State:

* Postcode:

* Phone:

* Email:

* Date Of Birth:

* Current weight (kg):

* Weight lost (kg)

Before Photo

After Photo

* How long did this take you in weeks?

* Tell us in 20-100 words how losing yours weight has changed your life:

* Which Xantrax products have you included in your weight loss regime:

Shakes
Pills

How did you hear about Xantrax?

Body & Soul		Friends
Fitness Magazine		Retailer
Internet		Doctor

* I have read, understood and accepted the Terms and Conditions

Thank you for your time, and best wishes on your weight loss journey