BSTTW Free Permanent Cosmetics & Tattoos E-Form


BSTTW
Translations

BSTTW is offering free permanent cosmetics, skin needling, scar relaxation, corrective make-up and tattoos to burn survivors who cannot afford the treatment and would like to have it done.

Any burn survivor can apply. Your application will be evaluated. BSTTW will not be responsible for the services you receive, the cost for transportatoin to and from the office and we do not guarantee that you will be accepted, that we have a Permanent cosmetic specialist within your area or that the specialist in your area has already met his or her quota of free services for BSTTW.

In order to apply fill the form out and click Submit. If we have a specialist in your area that might accept your case, a BSTTW Representative will contact you for pictures of the area you would like to have worked on and any other information we might need.


BSTTW Permanent Cosmetic & Tattoos E-Form

Please fill out the form below to create an account:

*First Name
*Last Name
*Date of Birth:
*Gender:
*Email Address
*Street Address
Street Address
*City
*State/Province
*Zip-Postal Code
*Country/Region
*Home Phone Number
  Work Phone Number
*Are you a Burn Survivor?
*Which free cosmetics are you   applying for?
*Description:

* must be filled out