Do you love Proactiv?®

Your Information

• Title Mr Mrs Miss Ms
• First name *
• Last name *
• Address *
• Suburb *
• State *
• Postcode *
• Email address *
• Confirm email address *
• Phone Number
  (incl. Area Code) *
• 
  Age * < 18 years 18-24 years 25-29 years 30-39 years 40+ years
• 
  Gender * MaleFemale
• Describe your skin and breakouts. How often? Since what age? How severe? *
• How has the condition of your skin affected relationships, social activities, school,
  and work? *
• What products have you tried? (dermatologist, prescriptions, over the counter
  products, etc.) *
• What made you decide to try Proactiv? *

To submit your before and after photos, use the browse buttons to select the .jpg or .gif photos you wish to submit from your hard drive. Each photo should be no larger than 1MB in size.

Upload your before and after photos

• Date your Before Photo was taken (dd/mm/yyyy) *
• Before Photo *
• After Photo

To submit your video testimonial, use the browse button to select the video you wish to submit from your hard drive. The video should be no larger than 25MB in size.

Upload a video of yourself telling your story

• Video

You must be 18 years of age or older to submit a photo. If you are a minor, please have your parents submit a photo for you. We will notify you if you are selected for further consideration to appear in one of our Proactiv advertisements. By submitting your photos and the completed questionnaire to us, you authorise us to disclose both the photos and the information contained in your completed questionnaire to our production consultant(s) for the purpose of determining whether you will be selected to appear in one of our Proactiv advertisements. Other than for the purpose stated above we will retain your photos and completed questionnaire on file and will not disclose or use your photos or the information contained in your completed questionnaire for any other purpose without your express written permission. Please note that we do not return photos or completed questionnaires and all photos and completed questionnaires submitted to us become the property of Guthy-Renker Australia Pty Limited.