 Creating Ultimate Smiles 51 Mill Street, Suite 10 Hanover, MA 02339 781-826-8395 |
 Charles David Salon Number Six Grove Street Norwell, MA 02061 781-982-1224 |
Contest Closed - Winner to Be Announced July 18th
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Applicants must provide 4 photos - full face-smiling, left face profile-smiling, right face profile-smiling (please show as much of your teeth as possible) and full length, head to toe photo. Photos must be clearly labeled with your name and phone number. Digital photos should be name with your full name and numbers 1 - 4 (JaneSmith1.jpg) All photos will become the property of Creating Ultimate Smiles & Charles David Salon and will not be returned.
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Deadline for applications is midnight, June 30, 2005. Applications will be accepted by mail.
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The winner will be required to sign a release form that allows both Creating Ultimate Smiles and Charles David Salon to use your name, makeover information and Before and After Photos for marketing purposes.
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The winner will need to be available between July 18th and September 25th for treatments and proceedures that will be outlined before we come to an agreement with the winner.
Please print legibly
Home Phone:
__________________________ Work Phone: ____________________________
Title/Position: ________________________________________________________
Address:_____________________________________________________________
Dates of Employment: _________________________________________________
__________________________ Age: _______________
__________________________ Age: _______________
__________________________ Age: _______________
__________________________ Age: _______________
__________________________ Age: _______________
__________________________ Age: _______________
What is the highest level of education that you've completed?
High School, Graduated in ______________
Trade/Technical School:
Major:____________________________ School Attended:____________________________
Associates College Degree:
Major:____________________________ College Attended:____________________________
Bachelor's Degree:
Major:____________________________ College Attended:____________________________
Master's College Degree:
Major:____________________________ College Attended:____________________________
Professional or Doctorate Degree:
Major:____________________________
College Attended:____________________________
How long have you lived on the South Shore? ________________________________________
Do you have any present intention of leaving the area for school, a job, etc.?_________
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Why do you feel you should receive an "Amazing Makeover"?
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What difference do you think it will make in your life?
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What areas of your appearance are you most unhappy with? Have you always felt that way? What event changed your image of yourself?
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Tell us about
yourself:
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Do you belong to any affiliations or organizations?
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Please list any allergies you have (Medications, Food, Hay Fever, Dust, Etc.)and your current treatment for them, if any:
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Besides altering your appearance, what is your biggest dream?
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Have you ever had any type of plastic or cosmetic surgery? If so, please list specific surgeries and the reasons for those procedures:
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I attest that the above is all true
Signature _______________________________________ Date ________________________
Eligibility Requirements:
1. All entries must be complete to be eligible
2. You must be a U.S. Citizen
3. You must be at least 21 years of age
4. You must be a resident of the South Shore area of Massachusetts
5. Entrants need not be present to win
6. No employee of Creating Ultimate Smiles, Charles David Salon, or American Computer Technologies, his or her spouse, or immediate family members and/or those living in the same household of each shall be eligible to win. Immediate family members include, but are not necessarily limited to, parents, brothers, sisters, nieces, nephews, aunts, uncles, cousins, and grandparents.
7. No substitution will be allowed and the prize may not be redeemed for cash or other considerations
8. You must not have been convicted of a felony or misdemeanor, other than a minor traffic violation, and have never had a restraining order or other injunctive relief entered against you. There must not be any outstanding warrants for your arrest.
9. You must not have appeared in any other publicized makeover program.
10. If selected, you will be required to sign an affidavit of eligibility and you must execute all waivers and release agreements required by Creating Ultimate Smiles and Charles David Salon and allow them to use your name and photographs in any marketing and/or advertising campaigns. Creating Ultimate Smiles and Charles David Salon retain use of voice, actions, likeness, name, biographical information and own all rights to any photographs, video or other media in connection with the contest. The contestant winner must provide a release in that regard. Creating Ultimate Smiles and Charles David Salon have the right to edit and alter any such materials. The winner will receive no compensation for such agreements and releases.
11. You must be available for appointments and treatments between July 18, 2005 and September 25, 2005.
12. You must have no physical or mental conditions that would be adversely impacted by the makeover.
13. Taxes, where applicable, are the sole responsibility of the winner
14. This contest is void where prohibited by law and is subject to the laws of the Commonwealth of Massachusetts.
15. Creating Ultimate Smiles and Charles David Salon are not responsible for any typographical or other error in the promotion of the contest, administration of the contest or in the announcement of the prizes.
16. Creating Ultimate Smiles' and Charles David Salon's decision with regard to all matters relating to the contest, including those matters not specifically addressed in these rules, shall be final.
Please send this application to one of the above addresses with your photos labeled with your name and phone number. All photographs become the property of Creating Ultimate Smiles and Charles David Salon and will not be returned.