Well&nbsp;now it's up to you. Will you take the USANA health and opportunity challenge? If you want to beat the odds and fight back against Father Time, then check out the USANA story, try the products, and start reaping the rewards that are waiting for you. Contact me with any of your questions and to explain how you can get started today to realize your dreams. Please take the time to fill out the following information. <bR><bR>
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*Required Information* 
<P></P>
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<TD><fONT face="Arial, Helvetica, sans-serif">*Name: </FONT></TD>
<TD><fONT face="Arial, Helvetica, sans-serif"><INPUT name=NAME size=50> </FONT></TD></TR>
<TR>
<TD><fONT face="Arial, Helvetica, sans-serif">*Street Address: </FONT></TD>
<TD><fONT face="Arial, Helvetica, sans-serif"><INPUT name=STREET-ADDRESS size=50> </FONT></TD></TR>
<TR>
<TD><fONT face="Arial, Helvetica, sans-serif">Apt. Number/Suite: </FONT></TD>
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<TR>
<TD><fONT face="Arial, Helvetica, sans-serif">*City: </FONT></TD>
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<TR>
<TD><fONT face="Arial, Helvetica, sans-serif">*State: </FONT></TD>
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<TR>
<TD><fONT face="Arial, Helvetica, sans-serif">*Zip Code: </FONT></TD>
<TD><fONT face="Arial, Helvetica, sans-serif"><INPUT name=ZIP size=36> </FONT></TD></TR>
<TR>
<TD><fONT face="Arial, Helvetica, sans-serif">*Country: </FONT></TD>
<TD><fONT face="Arial, Helvetica, sans-serif"><INPUT name=COUNTRY size=36> </FONT></TD></TR>
<TR>
<TD><fONT face="Arial, Helvetica, sans-serif">*Phone Number: </FONT></TD>
<TD><fONT face="Arial, Helvetica, sans-serif"><INPUT name=PHONE size=36> </FONT></TD></TR>
<TR>
<TD><fONT face="Arial, Helvetica, sans-serif">*E-mail Address: </FONT></TD>
<TD><fONT face="Arial, Helvetica, sans-serif"><INPUT name=EMAIL size=36> </FONT></TD></TR></TBODY></TABLE>
<P><fONT face="Arial, Helvetica, sans-serif"><bR>
Please select one box for each question.<bR><bR>
I am interested in:<bR>
<INPUT name=Interested-in type=radio value=Income> building a home-based business<bR>
<INPUT name=Interested-in type=radio value=Health> improving my health<bR><bR>
Level of information regarding USANA:<bR>
<INPUT name=Current-Info-Known type=radio value=Distributor> currently a distributor<bR>
<INPUT name=Current-Info-Known type=radio value=SomeInfo> have heard about USANA from others<bR>
<INPUT name=Current-Info-Known type=radio value=Stranger> am a complete stranger to USANA<bR><bR>
What would you like for me to send you:<bR>
<INPUT name=Current-Info-Known type=radio value=3-day> A 3-day supply of Usana supplements<bR>
<INPUT name=Current-Info-Known type=radio value=SomeInfo> More information regarding Usana (pamphlets,cataloges, ect)<bR>
<INPUT name=Current-Info-Known type=radio value="lemon bar"> a free Lean lemon Fibergy bar (limit one)<bR> </FONT></P>
<P>
<fONT face="Arial, Helvetica, sans-serif">
I am interested in: (at this time these reports can only be e-mailed to you)<bR>
<INPUT name=Interested-in type=radio value=Income1 checked> building a home-based business<bR>
<INPUT name=Interested-in type=radio value=CoenzymeQ10>   Coenzyme Q 10<bR>
<INPUT name=Interested-in type=radio value=DiabetesMellitus>   Diabetes Mellitus<bR>
<INPUT name=Interested-in type=radio value=Fibromyalgia> Fibromyalgia<br>
<INPUT name=Interested-in type=radio value=Menopause>   Menopause<bR>
<INPUT name=Interested-in type=radio value=Osteoporosis>    Osteoporosis<bR>
<INPUT name=Interested-in type=radio value=PremenstrualSyndrome>    Premenstrual Syndrome<bR>
<INPUT name=Interested-in type=radio value=RheumatoidArthritis>    Rheumatoid Arthritis<bR>
<INPUT name=Interested-in type=radio value=USANADIFFERENCE>    USANA DIFFERENCE<bR>
<INPUT name=Interested-in type=radio value=ThePowerofDuplication>  The Power of Duplication<bR>
<INPUT name=Interested-in type=radio value=blah12>     more reports coming soon!<bR><bR>

How did you find this web page? <SELECT name=Where-Did-You-Find> <OPTION selected>Search Engine</OPTION> <OPTION>Referred by USANA Distributor</OPTION> <OPTION>Email</OPTION> <OPTION>My Business Card</OPTION> <OPTION>Friend</OPTION> <OPTION>Linked From Another Site</OPTION> <OPTION>Other</OPTION></SELECT> </FONT>
</P>
<P><fONT face="Arial, Helvetica, sans-serif">If referred by someone else, or linked through a search engine, please provide the name: <INPUT name=referrer size=36> </FONT></P>
<P><fONT face="Arial, Helvetica, sans-serif"><bR>
<INPUT name=Submit type=submit value="Submit This Form">&nbsp;<bR><bR>
Thank you for taking time to fill out this form. Information on the USANA opportunity along with your&nbsp;individual request will be sent to you shortly. </FONT></P></FORM>
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