'Glow Girl' 6 Week Weight Group Loss Program Application
I'm so glad interested in the 6 Week Group Weight Loss Program to help you achieve your weight loss goal.

Please complete the following questions below and I will contact you within 24 hours to confirm your spot in the group and discuss the program structure, next steps and enrolment. Due to small group sizes, I only take a handful of motivated women. book a 15 minute discovery call if you are a right fit for the program.
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Email *
What is your first and last name? *
Mobile Number *
What is your current weight? *
What is your goal weight? *
What is your height? (cms) *
How active are you? *
What is your age? *
What are your biggest challenges with losing weight? (Motivation, lack of support, misinformation etc.) *
Do you currently follow a low carb lifestyle or tried it in the past? *
Any other comments you'd like to add?
How did you hear about Lane Wiederstein or the 6 Week Glow Girl Program? *
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