APPLICATION FOR PARTICIPATION IN (ASSESSING HAIR GROWTH BENEFITS OF APPLYING DINLOG HAIR REJUVENATOR ULTIMATE) FIELD TRIAL PARTICIPATION PROGRAMME
Questions marked by * are required.
1. Full Name of the Participant: *
2. Son of / Wife of *
3. Age in years *
4. Gender *
  • Male
  • Female
  • Other
5. Full Residential Address *
6. Email: *
7. Mobile Number(s) *
8. Educational Qualifications
9. Present Occupation *
10. Present Condition of Hair on Head with Photos attached *
11. Photos of condition of hair on head *
12. Do you agree to our Policy that only potential future buyers will be selected? *
13. Do you agree to give feedbacks without fail? *
14. Do you agree that no (any sort of) compensation is payable to you? *
15. Do you agree that you will not make any claims against the Company, as this is only a free voluntary trial participation programme? *
16. Do you agree to pay and buy (at Company fixed price) at your discretion after the Trial period is completed? *
17. Any other suggessions: