Why my Mom deserves
a Free Orthodontic Smile Makeover
This Mother’s Day, we are giving one lucky mom an absolutely Free Orthodontic
Smile makeover (Invisalign or Braces)
Contest open to everyone in the community—you don't have to be a patient to participate!
Tell us WHY WE SHOULD PICK YOUR MOM (in no more than 500 words)

Last date for entries & completed permission forms —Wed May 6, 2015 at 5pm

Winner will be declared on Friday, May 8 2015 on our Facebook page.

Dr. Bhagia and his team will select the most deserving entry.
Visit www.SpaceCenterOrtho.com to learn the rules of the contest
and how to submit your entry.
Call us at (281) 286 8945 or email [email protected]
for more information.
Contest Sponsored by:
Vijay Bhagia, DMD,MS
Space Center Orthodontics
Mother’s Day Orthodontic Smile Makeover Application
(1) Nominator’s Contact Information
(2) Mother’s (Nominee) Contact Information
Name(s):_________________________________
_________________________________________
Mother’s Name: ______________________________
Mother’s Age:_________
Age(s):___________________________________
Street
Address:_________________________________
_________________________________________
_________________________________________
Mother’s
Address:________________________________________
________________________________________________
________________________________________________
Mother’s Phone Number:__________________________
Phone Number:___________________________
Mother’s email:__________________________________
Email:____________________________________
Mother’s Occupation:______________________________
______________________________
(3) Essay
•
Why Do You Believe Your Mother Deserves A Orthodontic Smile Makeover? (500 words or less)
****Please type and attach to this application
(4) ***Please Attach:
• Essay
• 1 up-close picture of the nominated mother’s smile
(5) Sign this form verifying you understand and agree to the rules
Nominator: ________________________
(6) Mail To:
Space Center Orthodontics
Mother’s Day Orthodontic Smile Makeover
1140 Clear Lake City Blvd #C
Houston, TX 77062
OR Email [email protected]
Nominee: __________________________
Mother’s Day Orthodontic Smile Makeover Contest- Official Rules
1. Participants: The Space Center Orthdontics Mother’s Day Smile Makeover is free and open to legal
residents of the Houston Area only. No purchase is necessary and a purchase will
not improve your chances of winning. Employees
of Space Center Orthodontics and their immediate families are not eligible.
2. How to Enter: The Orthodontic Smile Makeover Contest runs from March 10, 2015 to May 6th,
2015. To enter, please submit your name, address, telephone number and e-mail address,
and a current close-up photo of your mother’s smile along with an essay (500 words or less)
explaining why your mother should receive the makeover. Entries must be mailed to: Space Center
Orthodontics, Mothers Day OrthodonticSmile Makeover, 1140 Clear Lake City Blvd #C, Houston, TX 77062 or
emailed to [email protected] and received by May 6, 2015 at 5pm.
Limit one entry per person and per envelope only. Each entry must be
complete to be accepted. All materials submitted become property of Space Center Orthodontics
and will not be returned.
3. Winner Notification: One winner from will be selected based the originality, creativity and
thoughtfulness of the entry. The above criteria will be weighed solely and exclusively by Space Center
Orthodontics staff and the decisions by the office are final. The winner will be notified via our
Facebook page and will be required to confirm identity and eligibility by signing
an Affidavit of Eligibility within 7 days of announcement to collect the prize or an
alternate winner may be selected.
4. Prize: One mother will be selected as the winner of the Orthodontic Smile Makeover Contest.
The prize will be free Orthodontic treatment provided by Space Center Orthodontics located in the Clear Lake Area of
Houston. They will use orthodontic appliances most appropriate for the case. Invisalign will be an option based on
whether the patient is eligible for Invisalign. Any additional/optional treatment is not part of the prize. The prize will
cover one set of placed appliances. Loss or repair of appliances is not covered by the prize.
There is no actual cash value to the prize. No portion of the unused prized may be redeemed for cash.
5. Property: All entries become property of Space Center Orthodontics, which assumes no
responsibility for late, misdirected or lost entries. Nothing that is entered will be returned. By
entering this Contest, entrants agree that all parts of their entries may be published by Space
Center Orthodontics. Winners consent that Sponsors may use the winner’s names,
photographs, or other likenesses, the winners’ hometown and biographical information, contest
entry and statement concerning the contest entry, without compensation for purposes of
advertising, promotion, and grant all rights to edit or modify and to publish and copyright it. All
information submitted by entrants as part of this Contest may be used by Sponsor to communicate
with entrant.
6. Limitation on Liability: By participating in this Contest, entrants and participants agree to release
and hold Space Center Orthdontics, its sponsors, directors, officers, employees and assigns,
harmless against any and all claims, causes of action, and liability arising out of the award and,
use of the Prize and their participation in this contest.
7. Law: Void where prohibited or restricted by law. Taxes, if applicable, are the sole responsibility
of the winner. Additional restrictions may apply. In the event that this contest is challenged by
any legal authority, Space Center Orthodontics reserves the right to discontinue or modify the
contest or disqualify any participant.