EmailMe Form - 30 Day Challenge Registration

Name
First Last
Email
Phone
### - ### - ####
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
At Viiva, I am a...
Brand Partner
Customer
Other
If you are Viiva Brand Partner, what is you Brand Partner ID number?
Please upload your BEFORE picture. *
Must be a .pdf, .png, .jpg, .jpeg, .gif, or .tif file. To be considered for publication in the Viiva Before and After Gallery, both photos must be taken in the same light, from the same angle and distance, with the same camera. Additionally, the individual must feature the same makeup and/or skin tone in both photos. Photos must contain only one individual. If two or more individuals are contained in the photos, each individual must complete a separate submission form.
Date BEFORE picture was taken: *
MM / DD / YYYY
Month you will begin the 30 Day Challenge: *
October
I acknowledge I must meet the following requirements to be considered to win.
Yes
•An order of at least 100PV is required during the month of submission.
•Submit both a before and after photo showing your weight loss or health transformation. This photo will be verified.
•Must post photos on social media tagging Viiva and using the hashtag #VIIVA30DAYS.
•Submit a testimonial and photo describing or showing any changes noticed for all the Viiva products used during the 30-Day Challenge.
•Each testimonial you submit must include Viiva products.
•All grand prize winners will be required to post their testimonial on social media and participate on a Viiva product training call or opportunity call.
What is your age?
18-25 years
26-35 years
36-45 years
46-55 years
56 years +
I do not wish to answer
Gender:
Male
Female
I do not wish to answer
What Viiva products did you use during the 30 day challenge?
Organic Protein Base
Amazon Superfruits
Organic Green Power
p3 Probiotics
Trim
Trim Max
NMN Premium
BioDerma Actives
Select all that apply.
Please describe your experience and outcome with each product selected above.
Please write a separate paragraph/section for each product.
Agree to Terms & Conditions
I agree
By checking this box, I hereby declare the above statements are true and correct. By checking this box, I also agree
• Duration: 30 days from enrollment or August 1, 2020

Challenge Periods:
• 1. August
• 2. September
• 3. October

Terms and Conditions
I am the subject of the photos and have the right to distribute these photos to VIIVA. The decision to share these photos with VIIVA is one that I have made willfully without coercion or external force. I acknowledge submission and/or the use of these photos by VIIVA does not entitle me to any compensation of any kind. I am submitting these photos free of charge to VIIVA. I acknowledge VIIVA has the sole discretion to determine if it will use my photos. I have no cause of action or right to compensation if VIIVA does not use my photos. I affirm the photos submitted are in the original form and have not been edited or otherwise altered to enhance my appearance or to accentuate any particular result. I declare the differences demonstrated in my photos are results I achieved with a healthy diet, regular exercise, and the incorporation of VIIVA products into my lifestyle. I confirm the photo dates indicated above are the dates on which the photos were taken.
I provide VIIVA with the explicit rights to use these photos(s) in the context of a product or experience testimonial. I agree VIIVA may display the photos online, in print, or in live events. In order to revoke these rights, I agree I must provide VIIVA with a written request for removal. I understand upon receipt of my written request for removal, VIIVA has 90 days to remove my photos from online materials and cease use of my photo(s) in any future printed materials.

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