Pre-Register

First name

Last name

Email address

City

What State Do You Live In?

Your Cell Phone

Birthdate

Gender

Ethnicity

Height (ex. 5'9”)

Weight (ex. 355)

Relationship Status

Do you have children?

What industry do you work in?

What Is Your Job Title? (ex: Physician, Teacher)

Personal Website URL (ex. http://www.extrememakeovercasting.com)

Facebook URL (ex. http://www.facebook.com/EMWLECasting)

Please Upload a Clear Recent Photo of Yourself (no hats or sunglasses please)

Please ensure your image is less than 8MB and in one of the following file formats : png, jpeg, jpg, gif, bmp, tiff

Please Upload a Clear Recent Full Body Photo of Yourself

Please ensure your image is less than 8MB and in one of the following file formats : png, jpeg, jpg, gif, bmp, tiff

I Plan On Applying By:

Tell us a little about your weight gain (ie. I gained weight after having children, after playing sports, after a specific event, or I’ve been overweight most of my life, etc)

Why do you want to lose the weight? (ie. To have children, run a marathon, get married, wear a bikini, etc)

Have you ever applied to be on a TV Show before?

If YES, which ones and did you appear?

How did you hear about the casting for Extreme Makeover Weight Loss Edition? Please Be Specific: (i.e. Today Show, Holland’s Twitter, The Show’s FB page, Craigslist...etc.)?

I would like to receive email updates and casting notices from Eyeworks

By submitting the information requested above, I agree that I have read, meet and agree to the Eligibility Requirements, Additional Requirements and Releases, available here as well as the Eyeworks Privacy Policy available here