Binding Contract of Commitment with the
"Person in the Mirror"

Name: ________________________________

I, as Agent for the "Person in the Mirror," agree to perform everything as to complete the following weight loss goal:

Current Weight: __________
Weight Loss Goal for this Agreement: __________
Target Weight: _________
Date: __________

Date: __________

I hereby commit to starting today to achieve the weight loss that I know I want and need to feel good about myself. I hereby take sole responsibility for my weight and am willing to make permanent changes in my diet and exercise habits.

From this day forward I will no longer be denied the success I deserve. This is an important day in my life, the day I make a final commitment to do what needs to be done, to consistently focus on my goal and eat healthy, every hours, every day, every week from here forward. I will no longer make excuses or justify my current unhealthy diet and lifestyle.

I understand that my weight loss goal is going to be reached by developing new healthy habits overtime. I understand that I will not have to settle with my current weight. I have the power to change my relationship with food to one that supports my desire for a new healthy lifestyle.

Signature of Commitment
As I sign this contract. I understand that my future is my
responsibility and I recognize I am capable of achieving my goal.


I, as Agent for the "Person in the Mirror," upon the completion of this goal accept congratulations and realize that I can do anything that I want and be anything that I want. I have succeeded in setting and achieving one the most important life goals - a healthy weight.

I have taken a major step toward being the person I want to be. I take great pride in knowing that I have successfully planned and reached my weight loss goal.

I am one large step closer to my final target weight goal. Reaching my final target weight is a series of successful smaller goals.

Date Goal Fulfilled__________________20_____
Agent for the "Person in the Mirror"

Number of pounds Lost: __________
Current Weight: __________
Final Target Weight Goal: _________

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This Proposal and Agreement must be filled out in full and dated with starting and completion dates.

Use this Proposal and Agreement for a 30 day period, no matter how small or large your weight loss goal. Your goal, is to be treated with great respect as it is a reflection of your true needs and desires.

Your goal should be very descriptive and explicit. It should paint a very clear picture of what you want to achieve and when. Set a goal that is realistic, achievable and moves you forward.

Read your agreement in front of the mirror every day with great conviction, make your weight loss goals a part of your subconscious thinking.

When a goal is reached, sign as agent for "The Face in the Mirror" and then write in large red letters on the face of the contract, "This contract fulfilled". Save all of these contracts and keep them in order by date completed, so as to see a growth pattern. You will be able to draw great strength from this series of accomplishments, no matter how small they may seem at first, they add up to success.

Remember, you can reach your target weight by following the plan. Each of these goals, no matter how small, become a part of that plan and help you transition to the weight you want to be.

If you want your life to change, you have to change what you are doing. So get turned on and get into gear. You can do it - You can change and become the person you want to be. As Nike says "Just Do It." No one is holding you back any longer.