SignUp | Darby Dental Gas Contest

OFFICIAL ENTRY Please fill out the official entry information below, then click enter. Shortly, you will be sent an email that your official entry has been received…Simply click on the confirming link and you're done. This is essential to make sure that you are the actual person that has entered, and if you win, the prize goes specifically to you. Each month (July, August & September 2008) someone will win!...and there's nothing to buy! GOOD LUCK!
First Name:
Last Name:
E-Mail:
Practice Name:
Address:
Address 2:
City:
State:
Zip Code:
Phone:	- -
Number of locations our practice has:	1 2 3 4 5+
Number of Dentists in our practice:	1 2 3-5 5-9 10+
My occupation is:	Dentist Hygienist Assistant Office or Purchasing Manager

CONTEST RULES: All entries shall become the property of Darby Dental Supply. Darby Dental Supply is not responsible for lost, misdirected or delayed entries. Entries received by telephone, fax, mail, courier or personal delivery will not be accepted. Employees of Darby Dental Supply, its contest sponsor, advertising and promotional agencies and their respective affiliates and associates and such employees' immediate family members and persons with whom such employees are domiciled are excluded from this contest. The prize is not redeemable in cash and must be accepted as awarded. Decisions of the contest judges are final - no substitutions will be available. By claiming the prize, the winners authorizes the use, without additional compensation of his or her name and/or likeness and/or voice/photograph and municipality of residence for promotion and/or advertising purposes in any manner and in any medium (including without limitation, newspapers and other publications, slides, videotape, distribution over the internet and picture data storage) which Darby may deem appropriate. Note: Prize winner may be subject to taxes. In accepting the prize, the winner, acknowledges that Darby Dental Supply may not be held liable for any loss, damages or injury associated with accepting or using this prize(s). Winners will be selected randomly by the Darby Dental Gas Contest Computer -- and will be notified via email, approximately 7 business days after the close of each month. An entrant can only win once during this contest. Entries are available to all active licensed dental practitioners, hygienists, assistants, office & purchasing managers currently working in a dental practice. © copyright 2008, Darby Dental Supply, LLC.

	I agree to the contest rules above.

OFFICIAL ENTRY