| FAV 5 Referral Contest |
 Refer your friends to Applegate Dentistry and WIN a $100 Visa gift card! How? Use the form below to recommend Dr Applegate's website to your friends. If at least 5 of your friends become our patient - you win!
INSTRUCTIONS:
- You must enter your name and email address.
- You must enter at least one (1) name and email address of a friend.
- You can enter up to five (5) friends at a time using the form below.
- If you want to refer more than 5 friends, simply repeat this process.
- The contest begins September 1, 2008 and ends March 31, 2009.
To win the prize, remember that 5 friends need to come in for a new patient appointment. The stronger your recommendation, the more likely that your friends will make an appointment... So be sure to use the personal message box at the end of the form!
NOTE: The name and email address that you enter in the fields below will appear in the emails you send to your friends.
Fields marked with ** are required.
Thanks for entering the Applegate Dentistry Fav 5 Referral Contest!
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