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SMILE-A-THON ONLINE ENTRY FORM



Name:                                                 Email: 
Address:                                                Phone:
City:              
State:       
*Age:       

*If you are under the age of 18, then please include your parent's name below.
Parent's Name/Permission:

Yes, I've read & I agree to the contest rules & conditions.


PLEASE CHOOSE BELOW THE CATEGORY THAT YOU WOULD LIKE TO ENTER INTO:

Select only one
Most Beautiful Smile(female)
Most Handsome Smile(male)


ENTRY FEE AMOUNT:

$20 = Entry fee(selected from above)

Please select your total entry fee amount:



METHOD OF PAYMENT: Please select the method of payment that you choose to pay by:

Money order Check PayPal



STOP!!


BEFORE YOU CLICK SUBMIT, PLEASE MAKE SURE THAT YOU'VE DONE THE FOLLOWING:


Step 1: Read the contest rules and agree to its terms & conditions(check the box in section 1, above).
Step 2: Fill out completely the entry form, and send it by email or mail.
Step 3: Pay & Send the entry fee amount of $20.00 by mail(money order/check) or online through PayPal.
Step 4: Send a picture of your smile by mail or email.
Step 5: Be sure all of the items above are sent together(by mail or email) with your contact information by
           November 30, 2005.