First Name *

Last Name *

Best telephone number to reach you at (Day) *

Best telephone number to reach you at (Evening) *

Email *

City *

State *

What is your Date of Birth? *

I am a legal U.S. resident? *

Height *

Weight *

Gender *

Marital Status *

Occupation *

Brief Bio *

How many children do you have? *

What are your passions, hobbies and interests? *

List three interesting facts about you/your life *

Tell us a little about your crush *

Have you ever been thin or have you always been overweight? Explain/Give us some backstory on your weight gain. *

Other than your crush, what other goals have you put off pursuing because of the weight?

Please upload a photo (headshot) *

Please upload a photo (full body shot) *

Upload a Quick and Easy Video telling us why you want to audition for Weight Loss For Love!

Have you already spoken with a member of our casting team on the telephone about this opportunity? If so, what was their name? *

How did you hear about his opportunity? *

If someone referred you to apply, please tell us their name (be as specific as possible)

Facebook URL

Instagram URL