Voucher Form | Malferd Lerner

Register For Your Voucher

Full Name

Phone

Gender

Male

Female

Who Recommened You? Required

Hospital

Friend

Other

Home Address

Doctors Name

Name & No of your beauty salon

Hospital Registration Card (This could be your appointment details; no medical details necessary)

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Upload supported file (Max 15MB)

Please submit a current photo of yourself

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Upload supported file (Max 15MB)

Disclaimer All services are performed by qualified beauticians, and all products used, including nail varnishes, creams, and oils, are safe according to the manufacturer's guidelines. However, we cannot accept responsibility for any allergic reactions that may arise due to your condition. Please be assured that we will take every precaution to ensure your safety. By ticking this box, you acknowledge that you have read and agree to this disclaimer. Note: The voucher is valid for six months.

WE HAVE TO VERIFY YOUR INFORMATION NOT TO BE INTRUSIVE BUT TO AVOID SCAMMERS SO OUR GIFTS WILL GO TO THE RIGHT PERSON. YOUR INFORMATION WILL BE HELD IN THE STRICTEST CONFIDENCE AND WILL NOT BE PASSED ON TO ANY THIRD PARTY AND WILL BE USED SOLELY FOR THE PURPOSE OF VERIFICATION FOR YOUR FREE GIFTS AND FOR FURTHER GIFTS TO COME.

WE WILL DO ALL WE CAN TO HELP, SO THAT PEOPLE THAT ARE EFFECTED BY CANCER. GET THE SUPPORT THEY NEED.

Thank you, we will be in touch soon with more information on your voucher code. The Malferd Lerner Foundation