Clippers for a Cause

CLIPPER REQUEST FORM

THIS PROJECT IS OPEN WHILE SUPPLIES LAST

*THIS APPLICATION IS DISTRIBUTED BY INVITATION ONLY. UNAUTHORIZED INDIVIDUALS COMPLETING THIS SURVEY WILL BE DENIED.

Who is eligible?
*Individuals who currently attend barber or cosmetology school.

*Individuals who volunteer to provide no-charge haircuts to not less than 5 persons who are clients of an emergency/transitional shelter or a student currently enrolled in a college/university within the current year.

ATTENTION: Completing the following application does not guarantee approval to receive free equipment or products from the Wahl Clipper Corporation. The RBCF reserves the right to deny a request if we cannot verify any of the following answers stated on this form. Please allow up to ten business days for email notification of acceptance. Email all questions to Robert W. Cradle, RBCF Managing Director at rcr365@aol.com

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* 1. List today's date here

Date

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* 2. Contact Information

Name (first & last)

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. List the name, phone number and director of the barber or cosmetology school that you attend(ed) below

School Director

Name of School

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number

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* 4. List the date that you will complete (or completed) barber or cosmetology school (Date listed on your certificate)

I COMPLETED school on the following date

I WILL COMPLETE school on the following date

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* 5. List the registration number on your student or apprentice license here

List number here

N/A (place "0" in this box)

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* 6. Is the target group for your proposed volunteer grooming services...

Clients of an emergency; transitional or residential shelter (also includes group homes)

Students currently enrolled in college or university

Title One public school students (primary and/or secondary)

Other (please specify)

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* 7. List the date of your volunteer grooming services here

MM/DD/YYYY

Date

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* 8. List the number of individuals groomed or you expect to groom on your volunteer grooming date (place a numeric value only)

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* 9. List the name of the location and the address where you will provide the volunteer grooming services here

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* 10. Is your volunteer service a part of a larger event?

Yes

If "YES" explain the event here:

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* 11. How many Wahl brand clippers do you currently own?

More that 5

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* 12. If this application is approved, how much more likely will you purchase a Wahl Clipper within the next 12 months?

Extremely Likely

Likely

Not So Likely

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* 13. I understand that by completing the following application does not guarantee approval to receive free equipment or products from the Wahl Clipper Corporation.

I agree to return an up-close photo of myself with my free Wahl clipper. Send your photo to (410) 245-8875.

By completing this form I hereby give permission to the Wahl Clipper Corporation and Rob's Barbershop Community Foundation to utilize any submitted photos for purposes of publicizing the "Clipper for a Cause Project".

I understand that Wahl Clipper Corporation and Rob's Barbershop Community Foundation will not replace or accept returns of any defective clipper once the merchandise has been received.

I agree

Question Title

* 1. List today's date here

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* 2. Contact Information

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* 3. List the name, phone number and director of the barber or cosmetology school that you attend(ed) below

Question Title

* 4. List the date that you will complete (or completed) barber or cosmetology school (Date listed on your certificate)

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* 5. List the registration number on your student or apprentice license here

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* 6. Is the target group for your proposed volunteer grooming services...

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* 7. List the date of your volunteer grooming services here

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* 8. List the number of individuals groomed or you expect to groom on your volunteer grooming date (place a numeric value only)

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* 9. List the name of the location and the address where you will provide the volunteer grooming services here

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* 10. Is your volunteer service a part of a larger event?

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* 11. How many Wahl brand clippers do you currently own?

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* 12. If this application is approved, how much more likely will you purchase a Wahl Clipper within the next 12 months?

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* 14. List any of your questions and/or comments here...