Nikwax

Nikwax Web Quiz Registration

 

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First Name *: 
Last Name *: 
E-mail address *: 
Store Name  : 
Address Line 1 *: 
Address Line 2 : 
City *: 
State/Province *: 
ZIPcode/Postal Code *: 
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Password
(min 5 characters) *: 
Password
(re-enter) *: 
 
 

Where did you hear about the Web Quiz?
(If from a friend then enter their email address) : 
What outdoor activities do you participate in? : 
Who is your favourite outdoor retailer? : 
What make is your favourite pair of walking boots? : 
What make is your favourite waterproof jacket? : 
Which outdoor magazine do you regularly read? : 
Did you buy your footwear waterproofing product at the same time you bought your boots? : 
Yes No
 
Did a friend who has already played and won recommend you to try the WEB QUIZ???
If yes, then please type in their e-mail address in the 'Where did you hear about the Web Quiz' box below. If three people quote them, then they get the chance to win again RIGHT AWAY, and don't have to wait 3 months for the next prize!
     
  We do not supply names, addresses or any other contact details to third parties. Nikwax or Paramo may contact you with information or invitations. Please indicate your preference below.

I would like to receive information and invitations by e-mail from Nikwax and Paramo
I would like to receive information and invitations by post from Nikwax and Paramo

 
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Nikwax North America 400 N34th Street Suite 202, Seattle WA 98103. T: 800 563 3057 F: 206 633 1459
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