1. Would you be willing to participate in this in-home trial?

Yes

No

2. Are you:

Female

Male

3. What is your age?

Under 18        18-24    25-29        30-34        35-39        40-44        45-49        50+

4. Do you have children under 18 living in your household?

Yes

No

5. Are you a current First reader?

Yes, but I am not a subscriber      Yes, I currently subscribe to First    No

6. Please provide your contact information and mailing address.

Name   Address Line 1Line 1   Address Line 2   City   State   Zip Code   Daytime Phone#   Email Address:

To sign up for the product trial, please read the Terms and Conditions and check the box below. To enter the sweepstakes, please read the Official Rules and check the box. If you would like to receive email communications from Dixie Consumer Products LLC or First, please check the appropriate box(es) below.