10 Years Younger in
21 Days

Entry Form

Welcome to The Style Consultancy Makeover Competition application. You may apply for yourself or nominate someone you believe deserves this special transformation. Please complete all required fields — your information is important to us. Competition entried close on Monday 4 August.

Are you applying for yourself or nominating someone else? *Applying for myselfNominating someone else

If you are nominating someone else, please provide the following information

Your Name and Surname

Your Email Address

Your Contact Number

Applicant / Nominee *Name and Surname

Applicant / Nominee *Age

Applicant / Nominee *Date of Birth

Applicant / Nominee *Email Address

Applicant / Nominee *Contact Number

Residential Area *Competition only open to residents within the Overberg region

Province

Applicant / NomineeQuestions

Any existing medical conditions or allergies we should know about? *Please list

Currently Pregnant / Breastfeeding *NoPregnantBreatfeeding

Are you currently taking any medications relevant to skin, hair, or cosmetic treatments? *Please list

Any skin sensitivities, conditions, or recent cosmetic procedures? *Please list

Have you had any aesthetic treatments done in the past? *BotoxDermo FillersSkinboostersBiostimulatorsPlastic SurgeryOtherNone

Willing to get aesthetic treatments done? *YesNo

Any crowns, implants, or other dental restorations? *Please list

Willing to get your teeth whitened? *YesNo

Do you have any other health considerations relevant to this competition or treatments? *

Are you willing to get your hair done? *YesNo

Are you willing to change your style? *YesNo

Are you willing to appear on Social Media? *YesNo

Why are you or your nominee the ideal candidate for this competition

Please upload a recent head and shoulder photo of applicant / nominee *

No file chosen

Any other comments or information you wish to share?

How did you hear about this competition? *FacebookInstagramGoogleOther

I confirm that the information I have provided is true and accurate. I understand that the winner will be selected based on the application and sponsor criteria. *Yes

I confirm that I have read and I agree to the Terms & Conditions. *Read our Terms and ConditionsYes

I consent to my photos and personal information being used for promotional purposes related to this competition. *Yes

Please do not fill in this field.

10 Years Younger in21 Days

Entry Form

10 Years Younger in
21 Days