*first name  
*last name
*date of birth
 
 
 
*e-mail
*city
 
*state
*where did you buy your outfit?
 
describe what you are wearing  
   
*upload your photo
Images should be in .jpg or .gif format and smaller than 500k.
   
*6 digit Transaction # what is this
All submissions become property of 10 Spot/MadRag;
They may be edited and may be published and otherwise used in any medium

*required fields
  I have read and accept the contest rules