1. *Please provide us with your birth date:

Month: --Select--> Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day: --Select--> 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: --Select--> 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

2. *Which types of skin care products do you, or would you, use? (Select all that apply)

Body Moisturizer Tanning Moisturizer Skin Firming Moisturizer Body Oils Shower Gel Body Wash Exfoliating Wash Bar Soap Hand Moisturizer Lip Balm Lip Gloss Lipstick Lip Plumper Anti-aging lip products Anti-aging Body Moisturizer

3. *Which NIVEA products are you interested in? (Select all that apply)

Smooth Sensation Smooth Sensation Body Oil Smooth Indulgence Hand Cream Essentially Enriched Lotion Pure Moisture Lotion Original Moisture Lotion Good-bye Cellulite Gel-Cream Good-bye Cellulite Patches Good-bye Cellulite Body Beauty Program Natural Tone Creme Natural Tone Lotion Sun-Kissed Firming Moisturizer Skin Firming Moisturizer Q10 Age Defying Moisturizer NIVEA Soft NIVEA Creme

4. *How often do you use hand & body moisturizers?

- - - - - - - - - - - - - - - Select - - - - - - - - - - - - - - - - - - - - - -> Every day Twice a day Every other day Weekly Monthly N/A

5. *What matters most to you in your monthly newsletter? (Select one)

- - - - - - - - - - - - - - - Select - - - - - - - - - - - - - - - - - - - - - -> New product samples Upcoming NIVEA events Member-only offers Latest product information Savings coupons Skincare tips Exclusive Dermatology Professional information and Q&A N/A

6. *What are your interests? (Select all that apply)

Fashion Fitness Music Sunbathing / Tanning Travel Social Events Online Social Networking Entertaining Family/Friends Watching Movies Watching TV Celebrity News Other