Release Form

To claim your free pair of Raynaud's Disease Silver Gloves, please follow these steps:

Complete the release form below. Please include your name, address and email address so that we know where to send your FREE gloves!
We will check that the image that you have sent complies with our rules (see our gallery of Raynaud's disease images for an idea of what we're looking for)
We will email you when you're free gloves are on the way and you should receive them within a few working days of submitting your image


Name	*
Upload Your Picture Here	*
I am of full legal age and agree to RaynaudsDisease.com using my pictures for marketing purposes on their wesbite, social media channels, and for any other marketing purpose.	Yes *
I am happy for my submitted images to be combined with other images, text and graphics, and cropped or otherwise edited and altered.	Yes *
I recognise that I will receive no compensation other than a single pair of silver gloves for the use of my image.	Yes *
I hereby declare that I own the copyright to the submitted image.	Yes *

Your Glove Size	*
	See our listing for help selecting a size
Your Email Address	*
Delivery Address Line One	*
Delivery Address Line Two
Town / City	*
County
Postcode	*