Shake The Crave - Product Tester Intro Form Question Title * 1. First Name: Question Title * 2. Last Name: Question Title * 3. Shipping Address - Street (no PO Boxes accepted): Question Title * 4. Shipping Address - Street Line 2 (Optional): Question Title * 5. City: Question Title * 6. State/Province: Question Title * 7. Zipcode: Question Title * 8. Nation (if other than USA): Question Title * 9. Cell Phone Number: Question Title * 10. Email Address: Email Address: Question Title * 11. What is your height? (examples: 5'11", or 5 ft 11 in) Question Title * 12. What is your current weight? (pounds) Question Title * 13. What would you like to see take place in your health over the next 90 days as a result of following a healthy lifestyle program (please be as specific as possible): Question Title * 14. What has frustrated you most about diet programs in the past? Question Title * 15. What concerns you most about trying a new diet program? Question Title * 16. How much aerobic exercise like walking, jogging, cycling, etc. do you do each week? None Less than 30 minutes/week 30-90 minutes/week 90 minutes - 2 hours and 29 minutes 2 hours and 30 minutes or more Question Title * 17. How much anaerobic exercise (like strength training) do you do each week? None Less than 20 minutes/week 20-59 minutes/week 1 hour or more/week Question Title * 18. How would you describe your current eating habits? (select the answer that best fits you) I don't eat very healthy for the most part. I eat healthy some of the time. I eat healthy most (or all) of the time. Question Title * 19. Please rate your current energy level: 1 - No Energy / Tired All the Time 2 3 4 5 6 7 8 9 10 - Excess Energy / Energy All the Time 1 - No Energy / Tired All the Time 2 3 4 5 6 7 8 9 10 - Excess Energy / Energy All the Time Question Title * 20. Shake Flavor Preference: (This will determine how much of each flavor we'll send to you each month - you'll receive 4 containers total each month. You can change this at any time during the future. Simply let us know of any changes in flavor when you send your monthly progress email to us.) All Vanilla All Chocolate Half Vanilla, Half Chocolate 3 Vanilla, 1 Chocolate 1 Vanilla, 3 Chocolate Now click "Done" below, and you'll be taken to a page that will give you detailed instructions on taking your "Before" pictures and emailing them to us. Once we receive your "Before" pictures, we'll set you up to start the product test and start receiving monthly shipments of Shake the Crave Shake Mix for free! We'll also email you with further details and instructions. Done