| The * sign denotes required fields. |
| In order to join the "Mothers & Plasmon ... together" Club, you are kindly requested to fill in this online form. |
| Mother's Details |
| Mother's Name and Surname * |
|
| Address * |
|
|
| Town * |
|
| Post Code |
|
| Telephone * |
|
| Mobile |
|
| Email Address * |
| |
| Child's Details |
| Child's Name * |
Date of Birth * |
Gender * |
|
|
|
| Membership is open only to mothers of children under 3 years of age (and is free of charge) |
| Other Children |
| Child's Name |
Date of Birth |
Gender |
|
|
|
|
|
|
| Information |
| Where did you first hear about the "Mothers & Plasmon ... together" Club? |
|
|
| Your Comments |
| We would appreciate your comments to further enhance our product range and services to you. |
|
| Your Friend's Details |
Do you have a friend who may wish to join our club?
If Yes, please fill-in her details and we will contact her as soon as possible. |
| Mother's Name and Surname |
|
| Child's Name |
|
|
| Telephone |
|
| Terms & Conditions |
| 1. Membership in the "Mothers & Plasmon... together" Club is free of charge. |
| 2. Membership is open ONLY to mothers of children under 3 years of age (and is free of charge). |
| 3. The administrators of the club reserve the right to discontinue this service without any obligations. |
| 4. Being accepted in the Club entitles you to regular updates and other promotional material regarding weaning and general babycare subjects. |
| 5. The data provided in this membership form will be processed by Vivian Corp Ltd. only for the general administration and for correspondence with members as required for the running of this club. Under no cirumstances will this data be passed on to third parties. |
|
| |
|
