rewards.valley-weightloss.com
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18.238.4.46
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URL:
https://rewards.valley-weightloss.com/
Submission: On November 22 via api from US — Scanned from US
Submission: On November 22 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
<form ng-submit="register(registrationForm)" class="ng-pristine ng-valid ng-valid-date" style="">
<div class="form-fields">
<!-- ngRepeat: field in formFields | orderBy:'position' -->
<div class="form-group ng-scope" ng-repeat="field in formFields | orderBy:'position'" style="">
<!-- ngIf: custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() === field.name -->
<!-- ngIf: custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() === field.name -->
<!-- ngIf: (!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date' --><ga-form-field
ng-if="(!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date'" field-type="input" is-required="true" pristine="pristine"
model="registrationForm[field.name]" rules="registrationFormValidation[field.name]" label="First Name" validated-field="validatedFields[field.name]" additional-params="field.additionalParams" validation-wait="0"
error-message="fieldErrors[field.errorMessage]" options="field.options" default-dropdown-text="" class="ng-scope ng-isolate-scope">
<div class="form-group ng-scope"> <!-- ngIf: label --><label ng-if="label" class="ng-scope">First Name<!-- ngIf: showAsterisks!==false --><span ng-if="showAsterisks!==false"
class="ng-binding ng-scope">*</span><!-- end ngIf: showAsterisks!==false --></label><!-- end ngIf: label -->
<div class="async-loader">
<div class="inner-field-wrapper " ng-class="{"inner-field-loading":loading}"> <input ng-trim="true" ng-model="model" ng-focus="focusCallback()" ng-blur="blurCallback()" placeholder=""
class="form-control ng-pristine ng-untouched ng-valid ng-empty" type="text" colorpicker-parent="true">
<div class="color-preview" ng-style="{"background-color": model || "#ffffff", "border-color": colorPreviewBorderColor || "#e1e1e1"}"
style="background-color: rgb(255, 255, 255); border-color: rgb(225, 225, 225);"></div> <i ng-show="state=='working' || loading" class="fa fa-refresh fa-spin ng-hide"></i> <i ng-show="state=='success'" class="fa fa-check ng-hide"></i>
<i ng-show="state=='error'" class="fa fa-exclamation ng-hide"></i>
</div><span class="help-block ng-binding"></span>
</div>
</div>
</ga-form-field><!-- end ngIf: (!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date' -->
<ga-form-field ng-show="field.type === 'date'" field-type="date" label="First Name" model="registrationForm[field.name]" additional-params="datepickerWithButtonConfig" is-required="true" pristine="pristine" rules="[]"
validated-field="validatedFields[field.name]" error-message="fieldErrors[field.errorMessage]" class="ng-isolate-scope ng-hide">
<div class="form-group ng-scope"> <!-- ngIf: label --><label ng-if="label" class="ng-scope">First Name<!-- ngIf: showAsterisks!==false --><span ng-if="showAsterisks!==false"
class="ng-binding ng-scope">*</span><!-- end ngIf: showAsterisks!==false --></label><!-- end ngIf: label -->
<div class="async-loader">
<div class="inner-field-wrapper datepicker-field ">
<div class="input-group"><input type="text" ng-focus="focusCallback()" ng-blur="blurCallback()" class="form-control ng-pristine ng-untouched ng-valid ng-isolate-scope ng-empty ng-valid-date" placeholder=""
uib-datepicker-popup="MM-dd-yyyy" datepicker-options="additionalParams.dateOptions" is-open="additionalParams.isOpen" ng-click="toggleDatepicker($event, true)" show-button-bar="false" ng-model="model"
min-date="additionalParams.minDate" max-date="additionalParams.maxDate">
<div uib-datepicker-popup-wrap="" ng-model="date" ng-change="dateSelection(date)" template-url="uib/template/datepickerPopup/popup.html" class="ng-pristine ng-untouched ng-valid ng-scope ng-empty"><!-- ngIf: isOpen -->
</div> <span class="input-group-btn"> <button type="button" class="btn btn-default" ng-click="toggleDatepicker($event)"><i class="glyphicon glyphicon-calendar"></i></button> </span>
</div>
</div><span class="help-block ng-binding"></span>
</div>
</div>
</ga-form-field>
</div><!-- end ngRepeat: field in formFields | orderBy:'position' -->
<div class="form-group ng-scope ng-enter-prepare" ng-repeat="field in formFields | orderBy:'position'">
<!-- ngIf: custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() === field.name -->
<!-- ngIf: custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() === field.name -->
<!-- ngIf: (!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date' --><ga-form-field
ng-if="(!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date'" field-type="input" is-required="true" pristine="pristine"
model="registrationForm[field.name]" rules="registrationFormValidation[field.name]" label="Last Name" validated-field="validatedFields[field.name]" additional-params="field.additionalParams" validation-wait="0"
error-message="fieldErrors[field.errorMessage]" options="field.options" default-dropdown-text="" class="ng-scope ng-isolate-scope">
<div class="form-group ng-scope"> <!-- ngIf: label --><label ng-if="label" class="ng-scope">Last Name<!-- ngIf: showAsterisks!==false --><span ng-if="showAsterisks!==false"
class="ng-binding ng-scope">*</span><!-- end ngIf: showAsterisks!==false --></label><!-- end ngIf: label -->
<div class="async-loader">
<div class="inner-field-wrapper " ng-class="{"inner-field-loading":loading}"> <input ng-trim="true" ng-model="model" ng-focus="focusCallback()" ng-blur="blurCallback()" placeholder=""
class="form-control ng-pristine ng-untouched ng-valid ng-empty" type="text" colorpicker-parent="true">
<div class="color-preview" ng-style="{"background-color": model || "#ffffff", "border-color": colorPreviewBorderColor || "#e1e1e1"}"
style="background-color: rgb(255, 255, 255); border-color: rgb(225, 225, 225);"></div> <i ng-show="state=='working' || loading" class="fa fa-refresh fa-spin ng-hide"></i> <i ng-show="state=='success'" class="fa fa-check ng-hide"></i>
<i ng-show="state=='error'" class="fa fa-exclamation ng-hide"></i>
</div><span class="help-block ng-binding"></span>
</div>
</div>
</ga-form-field><!-- end ngIf: (!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date' -->
<ga-form-field ng-show="field.type === 'date'" field-type="date" label="Last Name" model="registrationForm[field.name]" additional-params="datepickerWithButtonConfig" is-required="true" pristine="pristine" rules="[]"
validated-field="validatedFields[field.name]" error-message="fieldErrors[field.errorMessage]" class="ng-isolate-scope ng-hide">
<div class="form-group ng-scope"> <!-- ngIf: label --><label ng-if="label" class="ng-scope">Last Name<!-- ngIf: showAsterisks!==false --><span ng-if="showAsterisks!==false"
class="ng-binding ng-scope">*</span><!-- end ngIf: showAsterisks!==false --></label><!-- end ngIf: label -->
<div class="async-loader">
<div class="inner-field-wrapper datepicker-field ">
<div class="input-group"><input type="text" ng-focus="focusCallback()" ng-blur="blurCallback()" class="form-control ng-pristine ng-untouched ng-valid ng-isolate-scope ng-empty ng-valid-date" placeholder=""
uib-datepicker-popup="MM-dd-yyyy" datepicker-options="additionalParams.dateOptions" is-open="additionalParams.isOpen" ng-click="toggleDatepicker($event, true)" show-button-bar="false" ng-model="model"
min-date="additionalParams.minDate" max-date="additionalParams.maxDate">
<div uib-datepicker-popup-wrap="" ng-model="date" ng-change="dateSelection(date)" template-url="uib/template/datepickerPopup/popup.html" class="ng-pristine ng-untouched ng-valid ng-scope ng-empty"><!-- ngIf: isOpen -->
</div> <span class="input-group-btn"> <button type="button" class="btn btn-default" ng-click="toggleDatepicker($event)"><i class="glyphicon glyphicon-calendar"></i></button> </span>
</div>
</div><span class="help-block ng-binding"></span>
</div>
</div>
</ga-form-field>
</div><!-- end ngRepeat: field in formFields | orderBy:'position' -->
<div class="form-group ng-scope ng-enter-prepare" ng-repeat="field in formFields | orderBy:'position'">
<!-- ngIf: custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() === field.name -->
<!-- ngIf: custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() === field.name -->
<!-- ngIf: (!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date' --><ga-form-field
ng-if="(!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date'" field-type="input" is-required="true" pristine="pristine"
model="registrationForm[field.name]" rules="registrationFormValidation[field.name]" label="Email" validated-field="validatedFields[field.name]" additional-params="field.additionalParams" validation-wait="1500"
error-message="fieldErrors[field.errorMessage]" options="field.options" default-dropdown-text="" class="ng-scope ng-isolate-scope">
<div class="form-group ng-scope"> <!-- ngIf: label --><label ng-if="label" class="ng-scope">Email<!-- ngIf: showAsterisks!==false --><span ng-if="showAsterisks!==false"
class="ng-binding ng-scope">*</span><!-- end ngIf: showAsterisks!==false --></label><!-- end ngIf: label -->
<div class="async-loader">
<div class="inner-field-wrapper " ng-class="{"inner-field-loading":loading}"> <input ng-trim="true" ng-model="model" ng-focus="focusCallback()" ng-blur="blurCallback()" placeholder=""
class="form-control ng-pristine ng-untouched ng-valid ng-empty" type="text" colorpicker-parent="true">
<div class="color-preview" ng-style="{"background-color": model || "#ffffff", "border-color": colorPreviewBorderColor || "#e1e1e1"}"
style="background-color: rgb(255, 255, 255); border-color: rgb(225, 225, 225);"></div> <i ng-show="state=='working' || loading" class="fa fa-refresh fa-spin ng-hide"></i> <i ng-show="state=='success'" class="fa fa-check ng-hide"></i>
<i ng-show="state=='error'" class="fa fa-exclamation ng-hide"></i>
</div><span class="help-block ng-binding"></span>
</div>
</div>
</ga-form-field><!-- end ngIf: (!custom.isWsjCompany(customizations.uid) || (custom.isWsjCompany(customizations.uid) && custom.getWsjTypeaheadField() !== field.name)) && field.type !== 'date' -->
<ga-form-field ng-show="field.type === 'date'" field-type="date" label="Email" model="registrationForm[field.name]" additional-params="datepickerWithButtonConfig" is-required="true" pristine="pristine" rules="[]"
validated-field="validatedFields[field.name]" error-message="fieldErrors[field.errorMessage]" class="ng-isolate-scope ng-hide">
<div class="form-group ng-scope"> <!-- ngIf: label --><label ng-if="label" class="ng-scope">Email<!-- ngIf: showAsterisks!==false --><span ng-if="showAsterisks!==false"
class="ng-binding ng-scope">*</span><!-- end ngIf: showAsterisks!==false --></label><!-- end ngIf: label -->
<div class="async-loader">
<div class="inner-field-wrapper datepicker-field ">
<div class="input-group"><input type="text" ng-focus="focusCallback()" ng-blur="blurCallback()" class="form-control ng-pristine ng-untouched ng-valid ng-isolate-scope ng-empty ng-valid-date" placeholder=""
uib-datepicker-popup="MM-dd-yyyy" datepicker-options="additionalParams.dateOptions" is-open="additionalParams.isOpen" ng-click="toggleDatepicker($event, true)" show-button-bar="false" ng-model="model"
min-date="additionalParams.minDate" max-date="additionalParams.maxDate">
<div uib-datepicker-popup-wrap="" ng-model="date" ng-change="dateSelection(date)" template-url="uib/template/datepickerPopup/popup.html" class="ng-pristine ng-untouched ng-valid ng-scope ng-empty"><!-- ngIf: isOpen -->
</div> <span class="input-group-btn"> <button type="button" class="btn btn-default" ng-click="toggleDatepicker($event)"><i class="glyphicon glyphicon-calendar"></i></button> </span>
</div>
</div><span class="help-block ng-binding"></span>
</div>
</div>
</ga-form-field>
</div><!-- end ngRepeat: field in formFields | orderBy:'position' -->
<label class="terms-checkbox">
<input type="checkbox" ng-model="registrationForm.terms" class="ng-pristine ng-untouched ng-valid ng-empty">
<span ng-bind-html="customizations.customization_uid.terms_text" class="ng-binding">By checking this box, you agree to our <a href="https://www.getambassador.com/terms" target="_blank">terms & conditions</a> and
<a href="https://www.getambassador.com/privacy" target="_blank">privacy policy</a>.</span>
</label>
<!-- ngIf: customizations.recaptcha_enabled -->
</div>
<input type="submit" class="submit-btn" value="Submit">
</form>Text Content
Safari Private Browsing Mode is not supported. Please use Safari's standard browsing mode. Log in EARN REWARDS -------------------------------------------------------------------------------- Sign up today and start earning rewards for referring your friends and family! REFER AND EARN! HELP US GROW AND EARN REWARDS! First Name* First Name* Last Name* Last Name* Email* Email* By checking this box, you agree to our terms & conditions and privacy policy. Become a Partner! word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word word mmMwWLliI0fiflO&1 mmMwWLliI0fiflO&1 mmMwWLliI0fiflO&1 mmMwWLliI0fiflO&1 mmMwWLliI0fiflO&1 mmMwWLliI0fiflO&1 mmMwWLliI0fiflO&1