Welcome to Space Coast Extreme Makeovers

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	ONLINE APPLICATION (You MUST be 21 to apply)
EMAIL
NAME	First: MI: Last:
STREET ADDRESS
CITY
STATE
ZIP
PHONE	(Home) \| (Cell)
AGE
DATE OF BIRTH	Month: Day: Year:
GENDER	Female Male
HEIGHT
WEIGHT
HAIR COLOR
EYE COLOR
WHY DO YOU WANT TO BE A MAKEOVER CANDIDATE?
WHAT WOULD YOU LIKE TO IMPROVE? WHY?
PLEASE READ THE FOLLOWING DISCLAIMERS:	All materials that you send (including photos) will be retained by the Space Coast Extreme Makeovers Team and become the property of the Space Coast Extreme Makeovers Team and will not be returned to you whether or not you are selected as a candidate. Any expenses you incur during the application process including but not limited to postage, shipping, materials preparation (photos, etc.), are solely your responsibility. Space Coast Extreme Makeovers Team will not reimburse you for these expenses. Only one entry per person is allowed. All decisions of the Space Coast Extreme Makeovers Team are final and absolute and not subject to inquiry. Space Coast Extreme Makeovers is not responsible for lost entries due to electronic transmission or postal failure. "Extreme Makeover" is a trademark of The American Broadcasting Companies, Inc. and furthermore, Space Coast Extreme Makeovers is not affiliated in any way with either The American Broadcasting Companies, Inc. or the "Extreme Makeover" television series. Even though our Extreme Team Specialists have not appeared on the show, they do specialize in many of the same procedures that are featured in "Extreme Makeover" the TV series. Your privacy is important to us. All applications sent are held in strict confidence by our Extreme Team Members & Staff.
This MUST be checked to be considered for a Makeover!	I have read and understand the disclaimers above.

Disclaimer:
Extreme Makeover™ is a trademark of The American Broadcasting Companies, Inc. and furthermore, Space Coast Extreme Makeovers is not affiliated in any way with either The American Broadcasting Companies, Inc. or the Extreme Makeover™ television series. Even though our Extreme Team Specialists have not appeared on the show, they do specialize in many of the same procedures that are featured in Extreme Makeover™ the TV series.

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