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Win COLD-FX!
> Win COLD-FX!
WIN* a year’s supply of COLD-FX
Please complete this brief on-line survey for the chance to
WIN
*
a year’s supply of COLD-FX.
See
Rules & Regulations
for details.
Your Contact Information
First Name:
Last Name:
Address:
City:
State:
-- Please select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone Number:
Email Address:
Your personal information will not be shared with any other marketers and will only be used by Afexa Life Sciences Inc. for the purposes you have consented to and in accordance with privacy laws and our
privacy policy
.
Yes, please include me on the mailing list for future COLD-FX information and promotions.
Yes, please include me on the mailing list for information about other products manufactured by
Afexa Life Sciences Inc.
1. Have you ever used COLD-fX before?
Yes
Which of the following statements best describes how you use COLD-FX?
-- Please select --
I take COLD-FX every day - all year round
I take COLD-FX every day - in the winter
I take COLD-FX as soon as I see people around me getting sick
I take COLD-FX when I feel the initial symptoms of a cold or flu coming on
I take COLD-FX when I am suffering from a full-blown cold or flu
No
Please select the most accurate statement.
-- Please select --
No - I am not worried about catching colds and the flu
No - I have a hard time remembering to take daily supplements
No - I would not take it daily - but I would use it when I start feeling sick
Yes - I am concerned about catching colds - but am not worried about the flu
Yes - I am concerned about catching the flu - but am not worried about colds
Yes - I am concerned with catching both colds and the flu
2. What is your gender?
-- Select --
Male
Female
3. What age group do you fall under?
-- Select --
18-29
30-45
45-65
65 or over
4. How did you hear about COLD-FX? (Please check all that apply)
Friend - family member or work colleague
Pharmacist or doctor
Story in the news mentioning COLD-FX
Search engine results (Google - Yahoo - MSN - etc.)
TV advertisement
Radio advertisement
Newspaper advertisement
Magazine advertisement
Outdoor billboards
Online Ads
Subway/Transit Ads Signage at a Sports Game