All you have to do is fill out this form and you'll received 
the newest skin care and keep fit information via email.
***Please kindly forward this form to your friends, thank you!!***
1. Do you think skin care is important?
very important important normal least important
 
2. How much time do you spend on skin care?
never 2 - 5 min. 10 - 20 min. over 30 min.
 
3. Do you fully understand about your skin?
Fully understand partially understand don't understand  
 
4. Do you have any skin problem(s)?
oily dry blackhead wrinkle freckle
sensitive baggy eye acne other
 
5. Do you have an interest in skin care techniques?
interested no interest    
 
6. Are you satisfied with your figure?      satisfied        not satisfied

Which part(s) of your body you want to improve?
belly arm foot
back lower part of the body waist
hip whole body other 
 
7. If there is a diet plan that does not involved exercise and decrease of food intake, you ...
want to know more information want to have a free trial are not interest
 
8. We're looking people that have interested in skin care, you...
would like to try have interest want to know more about the company not interest
 
9. We're looking people that are interested in part-time internet based work, you...
would like to try have interest want to know more about the company not interest
10. Personal Information (Please kindly fill in all the information, so that we can easy to handle.)
Name :    male female
Career :    Student employed housewife other
Age :   
Telephone (Day):   
Telephone (Night):   
 Best time to call:    daytime evening whole day  
Country :   
E-mail :   
Other Internet     
 Communication :  		   ---> 
 

***Please kindly forward this form to your friends, thank you!! ***