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<div dir="ltr" style=""><div class="form-body" style=""><h1 class="ss-form-title" style="">十天免費試減優惠</h1>
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<div class="ss-form-desc" style="font:inherit;white-space:-moz-pre-wrap;word-wrap:break-word;width:99%;margin:0;">請填寫以下問卷<br><br>更多資料請登入以下網址<br><a href="http://www.youfitfit.com" target="_blank" style="">www.youfitfit.com</a><br><br>如閣下不想再接受本公司的電郵廣告請回覆此電郵以便公司取消閣下之電郵地址<br>如有任何查詢 請電郵本公司宣傳部聯絡<br>All rights reserved for this Work From Home promotion. Please don’t delete or change the content. Thanks.<br>此在減肥計劃宣傳是受 =香港版權法約束 , 請勿隨意刪除及更改內容 , 謝謝<br></div>
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<div class="form-body" style=""><div class="ss-form" style=""><form action="http://spreadsheets.google.com/formResponse?formkey=cjQyVUlXMFZfalRfUmRXY1hmM2pxU2c6MA..&ifq" method="POST" id="ss-form" style="">
<br>
<div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-text" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_0" style="display:block;font-weight:bold;">姓名
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_0" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<input type="text" name="entry.0.single" value="" class="ss-q-short" id="entry_0" style=""></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-text" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_2" style="display:block;font-weight:bold;">年齡
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_2" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<input type="text" name="entry.2.single" value="" class="ss-q-short" id="entry_2" style=""></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-radio" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_1" style="display:block;font-weight:bold;">性別
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_1" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<ul class="ss-choices" style="list-style:none;margin:.5em 0 0 0;padding:0;"><li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.1.group" value="男" class="ss-q-radio" id="group_1_1" style="">
<label class="ss-choice-label" for="group_1_1" style="">男</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.1.group" value="女" class="ss-q-radio" id="group_1_2" style="">
<label class="ss-choice-label" for="group_1_2" style="">女</label></li>
</ul></div></div></div>
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<div class="ss-item ss-item-required ss-text" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_3" style="display:block;font-weight:bold;">身高
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_3" style="display:block;color:#666;margin:.1em 0 .25em 0;">cm</label>
<input type="text" name="entry.3.single" value="" class="ss-q-short" id="entry_3" style=""></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-text" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_4" style="display:block;font-weight:bold;">體重
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_4" style="display:block;color:#666;margin:.1em 0 .25em 0;">kg</label>
<input type="text" name="entry.4.single" value="" class="ss-q-short" id="entry_4" style=""></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-text" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_6" style="display:block;font-weight:bold;">聯絡電話
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_6" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<input type="text" name="entry.6.single" value="" class="ss-q-short" id="entry_6" style=""></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-text" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_5" style="display:block;font-weight:bold;">E-mail
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_5" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<input type="text" name="entry.5.single" value="" class="ss-q-short" id="entry_5" style=""></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-radio" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_8" style="display:block;font-weight:bold;">聯絡時間
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_8" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<ul class="ss-choices" style="list-style:none;margin:.5em 0 0 0;padding:0;"><li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.8.group" value="早上" class="ss-q-radio" id="group_8_1" style="">
<label class="ss-choice-label" for="group_8_1" style="">早上</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.8.group" value="下午" class="ss-q-radio" id="group_8_2" style="">
<label class="ss-choice-label" for="group_8_2" style="">下午</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.8.group" value="晚上" class="ss-q-radio" id="group_8_3" style="">
<label class="ss-choice-label" for="group_8_3" style="">晚上</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.8.group" value="任何時間" class="ss-q-radio" id="group_8_4" style="">
<label class="ss-choice-label" for="group_8_4" style="">任何時間</label></li>
</ul></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-scale" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_9" style="display:block;font-weight:bold;">減重決心
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_9" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<table border="0" cellpadding="5" cellspacing="0" style=""><tr><td class="ss-scalenumbers" style="text-align:center;"></td>
<td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_1" style="display:block;padding:0.5em 0 .5em;">1</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_2" style="display:block;padding:0.5em 0 .5em;">2</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_3" style="display:block;padding:0.5em 0 .5em;">3</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_4" style="display:block;padding:0.5em 0 .5em;">4</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_5" style="display:block;padding:0.5em 0 .5em;">5</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_6" style="display:block;padding:0.5em 0 .5em;">6</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_7" style="display:block;padding:0.5em 0 .5em;">7</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_8" style="display:block;padding:0.5em 0 .5em;">8</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_9" style="display:block;padding:0.5em 0 .5em;">9</label></td> <td class="ss-scalenumbers" style="text-align:center;"><label class="ss-scalenumber" for="group_9_10" style="display:block;padding:0.5em 0 .5em;">10</label></td>
<td class="ss-scalenumbers" style="text-align:center;"></td></tr>
<tr><td class="ss-scalerow ss-leftlabel" style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0;">最小</td>
<td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="1" class="ss-q-radio" id="group_9_1" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="2" class="ss-q-radio" id="group_9_2" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="3" class="ss-q-radio" id="group_9_3" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="4" class="ss-q-radio" id="group_9_4" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="5" class="ss-q-radio" id="group_9_5" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="6" class="ss-q-radio" id="group_9_6" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="7" class="ss-q-radio" id="group_9_7" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="8" class="ss-q-radio" id="group_9_8" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="9" class="ss-q-radio" id="group_9_9" style=""></td> <td class="ss-scalerow" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;"><input type="radio" name="entry.9.group" value="10" class="ss-q-radio" id="group_9_10" style=""></td>
<td class="ss-scalerow ss-rightlabel" style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0;">最大</td></tr></table></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-text" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_10" style="display:block;font-weight:bold;">你為什麼變胖
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_10" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<input type="text" name="entry.10.single" value="" class="ss-q-short" id="entry_10" style=""></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-text" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_11" style="display:block;font-weight:bold;">曾嘗試過的減重方法
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_11" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<input type="text" name="entry.11.single" value="" class="ss-q-short" id="entry_11" style=""></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-radio" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_12" style="display:block;font-weight:bold;">希望減幾公斤
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_12" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<ul class="ss-choices" style="list-style:none;margin:.5em 0 0 0;padding:0;"><li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.12.group" value="5公斤以下" class="ss-q-radio" id="group_12_1" style="">
<label class="ss-choice-label" for="group_12_1" style="">5公斤以下</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.12.group" value="5-10公斤" class="ss-q-radio" id="group_12_2" style="">
<label class="ss-choice-label" for="group_12_2" style="">5-10公斤</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.12.group" value="10-15公斤" class="ss-q-radio" id="group_12_3" style="">
<label class="ss-choice-label" for="group_12_3" style="">10-15公斤</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.12.group" value="15-20公斤" class="ss-q-radio" id="group_12_4" style="">
<label class="ss-choice-label" for="group_12_4" style="">15-20公斤</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="radio" name="entry.12.group" value="20公斤以上" class="ss-q-radio" id="group_12_5" style="">
<label class="ss-choice-label" for="group_12_5" style="">20公斤以上</label></li>
</ul></div></div></div>
<br> <div class="errorbox-good" style="">
<div class="ss-item ss-item-required ss-checkbox" style=""><div class="ss-form-entry" style="margin-bottom:1.5em;zoom:1;"><label class="ss-q-title" for="entry_13" style="display:block;font-weight:bold;">想減部位
<span class="ss-required-asterisk" style="color:#c43b1d;">*</span></label>
<label class="ss-q-help" for="entry_13" style="display:block;color:#666;margin:.1em 0 .25em 0;"></label>
<ul class="ss-choices" style="list-style:none;margin:.5em 0 0 0;padding:0;"><li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="checkbox" name="entry.13.group" value="腰臀" class="ss-q-checkbox" id="group_13_1" style="">
<label for="group_13_1" style="">腰臀</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="checkbox" name="entry.13.group" value="腹部" class="ss-q-checkbox" id="group_13_2" style="">
<label for="group_13_2" style="">腹部</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="checkbox" name="entry.13.group" value="大腿" class="ss-q-checkbox" id="group_13_3" style="">
<label for="group_13_3" style="">大腿</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="checkbox" name="entry.13.group" value="手臂" class="ss-q-checkbox" id="group_13_4" style="">
<label for="group_13_4" style="">手臂</label></li> <li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="checkbox" name="entry.13.group" value="全身" class="ss-q-checkbox" id="group_13_5" style="">
<label for="group_13_5" style="">全身</label></li>
<li class="ss-choice-item" style="margin:0;line-height:1.3em;padding-bottom:.5em;"><input type="checkbox" name="entry.13.group" value="__option__" class="ss-q-checkbox" id="other_option:13" style="">
<label for="other_option:13" style="">其他:</label>
<input type="text" name="entry.13.group.other_option_" value="" class="ss-q-other" style=""></li></ul></div></div></div>
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