Submission

CREATE MORE COLLAGEN ~

8 WEEK CHALLENGE
Name*

First NameLast Name
Date of birth*

MonthDayYear
Must be 18+ to participate
Email*

Confirmation Emailexample@example.com
What is your order number?*

Order number(3) must include purchase of CREATE MORE COLLAGEN challenge bundle or equivalent purchase of Super Serum Advance+ & Active Peel System (2)
Please take a moment to answer the following questions:
What skin care products do you currently use?*

CleanserTonerAntioxidant SerumEye CreamSpot TreatmentMoisturizerSunscreenVitamin C SerumFace OilRetinoidAHAs / BHAsOther
Are you using antibiotics, steroids, prescription retinoids, prescription acne treatments or have inflamed rosacea or any known allergy to any product ingredient?*

YesNo
Are you currently pregnant or nursing?*

YesNo
Upload BEFORE photo (1)*

Front facing, bare skin. Natural lighting, no filter. Eyes may be open or closed.
Cancelof
Upload BEFORE photo (2)*

Left profile, bare skin. Natural lighting, no filter. Eyes may be open or closed.
Cancelof
Upload BEFORE photo (3)*

Right profile, bare skin. Natural lighting, no filter. Eyes may be open or closed.
Cancelof
Upload AFTER photo (1)*

Front facing, bare skin. Natural lighting, no filter. Eyes may be open or closed.
Cancelof
Upload AFTER photo (2)*

Left profile, bare skin. Natural lighting, no filter. Eyes may be open or closed.
Cancelof
Upload AFTER photo (3)*

Right profile, bare skin. Natural lighting, no filter. Eyes may be open or closed.
Cancelof
Photo Release

I authorize The Glow Shop to use my submitted photos on Facebook, Instagram and other social media platforms. I authorize The Glow Shop to edit, copy or distribute the photos for social media advertising and marketing. I agree that all intellectual property rights belong to The Glow Shop. I agree that I will not recieve any monetary compensation for using of my photographs in social media platforms and email.
Client Signature*

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Date*

MonthDayYear
Date
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Submission

CREATE MORE COLLAGEN ~