SuperFan SuperStarSuperFan SuperStar

It's been a tough job, trying to change your lifestyle for the better. But you couldn't have done it without the help of your SuperFan! Your SuperFan has been such a tremendous support, you wanna tell the WORLD how lucky you are to have them! They deserve to have their moment of magnificence - their claim to fame!

Have an awesome SuperFan? Need some incentive to be a stupendous SuperFan for YOUR buddy? Here's your chance to show-off the glories of SuperFandom!

In 50 words or less, tell us why YOUR SuperFan is such a superstar!

And send us a picture, too! You'll be entered to win some really cool prizes for yourself and your SuperFan!

All the information you will provide in the data fields below remain confidential, used only for the purposes of the To Life! program.

About Yourself
Your Email
Your Name
Your Age
Your Address
 
Your City
Your Province/State
Your Country
Your Postal/Zip Code
Your Phone
 
About Your SuperFan
SuperFan's Email*
SuperFan's Name*
SuperFan's Age
SuperFan's Address*
 
SuperFan's City*
SuperFan's Province/State*
SuperFan's Country*
SuperFan's Postal/Zip Code*
SuperFan's Phone
Why your SuperFan is a SuperStar:

Send us a picture
To send us a photo of you and your SuperFan:

  1. click on the Browse button
  2. Select the directory where your image is
  3. Select the image filename.
  4. Click OK.
Photo Filename:




Unique Image

Canadian Diabetes AssociationHealth CanadaManitoba HealthYouville Centre