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Apply to be on Live Big with Ali Vincent

Do you need help living a happier and healthier lifestyle? Ali Vincent -- the he inspirational first female winner of NBC's "The Biggest Loser," who took that title in 2008 after shedding 112 of her 234 pounds -- wants to help you live big. Apply to be on "Live Big with Ali Vincent" -- a series that follows Ali on personal journey around the country to help others discover their true selves.

First Name:
Last Name:
Address:
City/State:
Zip Code:
Phone:
Email:
Current Weight:
Goal Weight:
Age:
Current Diet (if any):
Current Workout (if any):
About Yourself:
What is your weight preventing you from doing?
What activity do you dream of doing?
Why you should be selected:
Link to You Tube video: (not required)

	Please select file(s) to upload: Images (.jpg only) must be less than 500K.

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