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contest rules

1) Tell Us Why You Would Be The Best Person To Win The Lap-Band Surgery From Bandlandia!

In 100 words or less, let us know your story:
2) Please Fill In The Information Fields Below to Complete Your Entry:

Would you like us to contact you with more information
about this surgery, regardless of the contest results?
3) Height (Ft/In.):
4) Weight:
All fields are required.
First Name
Last Name
Address:
 
City:
State:
Zip Code
Phone:    
Email:
Date of Birth:
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