Name:  

Address:  

Phone #:  

Alternate Phone #  

Email:  

Gender:  Female     Male

Marital Status:  Single       Married     Divorced

Children:  Yes           No

How Many Children living in the household?:  

How old are they?:  

Do you own your own home?:  Yes           No

What branch in the military did you serve in?:  

Did you serve in a combat situation?:  Yes           No

If so, where?:  

Were you injured?:  Yes           No

If so, what injuries did you sustain?:  

Do you have any ongoing medical conditions that resulted from combat?:  

Why would you like a Home Improvement Makeover from Designing Spaces?:  

If the Designing Spaces Dream Team came to your house, what room in the house would be your Ultimate Project Makeover?:  

Please send me more information on the products offered by the companies in this sweepstakes.