Champions

Painmaster Champion Review Program
Participant Nomination Form

Step 1: Nominate participants below (up to 3 per store)

Step 2: We’ll send out Free Trial Units directly to participants at the store.

Champion Participant Nomination Form

Agent/Distributor*
Representative*
Email*

You will receive confirmation of the data entered here by email.
Store Name:*
Town/Suburb*
Store Phone*

Please include Area Code
Store Email*
Participants
Participant Name Participants Email Address