Curlfriends Ripple Effect Nomination Form

Curlfriends Ripple Effect Nomination Form

A quiet way to lift someone up with a small act of care. If you know someone in our community who could use a little extra support, you’re invited to nominate them below.
Your Full Name*

First NameLast Name
Your Email Address*
example@example.com
Your Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Selected nominee may receive a complimentary Curl Discovery Cut at Tawnia B Styling, one recipient chosen each quarter
Nominee's Full Name*

First NameLast Name
Nominee's Email Address*
example@example.com
Nominee's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Why are you nominating this person for the Ripple Effect?*
How do you know the person you are nominating?
Does the person you are nominating live in the Cowichan Valley or surrounding area?*

YesNo
Would the person feel comfortable receiving this gift?*

Yes I believe soI'm not sure but I think it would be meaningful
If selected, would they be open to being contacted directly?*

YesNoPossiblyI'm not sure
I understand this program is handled with care and discretion and not all nominees will be selected.*
Should be Empty: