GRAND GIVEAWAY OFFER
We are giving away GV Dental Kit with Luxating Winged Color Coated absolutely free, enter your details below to get a chance to win $1,370 worth of instruments.
Also, make sure to do the following to grab more chances of winning!
1. Like us on Facebook:
2. Follow us on Instagram and Twitter
3. Why not LinkedIN?
4. Don’t just stop! Invite your Veterinarian buddies and reach the highest score.
2. Follow us on Instagram and Twitter
3. Why not LinkedIN?
4. Don’t just stop! Invite your Veterinarian buddies and reach the highest score.
Don’t just stop! Invite your Veterinarian buddies and reach the highest score.
Hurry up! Waiting for a lot of fun, maximum entries, great scores and the Lucky winner.
The winner will be announced on 31st October, 2020
ENTER TO WIN
@include('includes.partials.messages')
{!! Form::open(array('method' => 'POST', 'id' => 'frm_enter_to_win')) !!}
{!! Form::label('email', 'Email Address:') !!} *
{!! Form::text('email', null, ['type' => 'email', 'required' => 'required', 'class' => 'form-control', 'placeholder' => 'Enter email address ...', 'id' => 'sp_email']) !!}
{!! Form::label('first_name', 'First Name:') !!} *
{!! Form::text('first_name', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter first name ...']) !!}
{!! Form::label('last_name', 'Last Name:') !!} *
{!! Form::text('last_name', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter last name ...']) !!}
{!! Form::label('company', 'Company:') !!}
{!! Form::text('company', null,['class'=>'form-control', 'placeholder'=>'Enter company name ...']) !!}
{!! Form::label('phone', 'Phone:') !!} *
{!! Form::text('phone', null,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Enter phone ...']) !!}
{!! Form::label('city', 'City:') !!}
{!! Form::text('city', null,['class'=>'form-control', 'placeholder'=>'Enter city ...']) !!}
{!! Form::label('state', 'State:') !!}
{!! Form::select('state',
$data['states']
,null
,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Please Select ...']) !!}
{!! Form::label('zip', 'Zip / Post Code:') !!}
{!! Form::text('zip', null,['class'=>'form-control', 'placeholder'=>'Enter zip / post code ...']) !!}
{!! Form::label('role', 'Your Role:') !!} *
{!! Form::select('role',
['Veterinarian' => 'Veterinarian', 'Dentist' => 'Dentist', 'Technician' => 'Technician', 'Office Manager' => 'Office Manager', 'Clinic Owner' => 'Clinic Owner', 'Associated with Hospital' => 'Associated with Hospital', 'Other' => 'Other']
,null
,['class'=>'form-control', 'required' => 'required', 'placeholder'=>'Please Select ...']) !!}
{!! Form::label('comments', 'Additional Comments:') !!}
{!! Form::textarea('comments', null,['class'=>'form-control', 'placeholder'=>'Additional Comments ...', 'rows' => '3']) !!}