Looking to shed a few extra pounds?

Looking to shed a few extra pounds? Today In New York is looking to feature someone who wants to spend two weeks working out with a celebrity trainer who is volunteering to help someone shape up and lose weight.

If you would like to be considered or want to refer a friend.

In addition to filling out the form below, please submit a photo with the applicant's name in the subject line.
You can submit your photo to fitnesschallenge@wnbc.com.

Gender:
Male Female

Name:


City and State:


Phone Number:


E-Mail Address:


Height: Weight:

Age:


Existing Injuries and Medical Conditions?


Why should you be chosen for the fitness challenge?




Don't forget to submit a photo with a name in the subject line to fitnesschallenge@wnbc.com!