Refills Story Contest Entry Form
Share your story and details, then confirm your consent to enter and allow publicity use.
Entrant Information
Full name
*
First Name
Last Name
Email address (the email on your Refills account)
*
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Reddit username
Story and Participation Details
Your story
*
How long have you been with Refills?
*
Please Select
0-3 months
3-6 months
6-12 months
12+
Starting weight
Current weight
Photo Uploads
Before Photo
Upload a File
Drag and drop files here
Choose a file
Cancel
of
After Photo
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Contest Consents
Consent checkbox
*
I have read and agree to the
Official Contest Rules
.
Publicity release
*
I grant Refills permission to use my story, first name, and any photos I submit in its marketing (website, email, ads, and social media), and I understand I received or may receive something of value for entering.
Age confirmation
*
I confirm I am 18 years of age or older.
Submit Entry
Should be Empty: