Complimentary Wig Nomination Form

Complimentary Wig Nomination Form

Submit your nomination for someone you feel deserves a free wig. This individual must currently be undergoing treatment or recovering from treatment associated with breast cancer. Selection will be based on the order in which we receive the nominations. The number of recipients will be based on the sales from our October 17th Jon Renau Truck Show. For each wig or topper sold at our event, we will be giving a wig away to a nominee...One for One.
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.
Nominee's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Your Full Name

First NameLast Name
Your Email Address
example@example.com
Reason for Nomination
If selected, the winner will receive a complimentary consultation with their choice of select wigs up to a $500 value and complimentary customizations. Care products or additional accessories not included.
Should be Empty: