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Mums Lounge Modibodi Reviewer Application
*
1.
Please tell us the following:
(Required.)
First name
Last name
Email address
*
2.
Please tell us your age:
(Required.)
18-24
25-34
35-44
45-54
Other (please specify)
*
3.
Please tell us your daughter's age:
(Required.)
8-10
11-13
14-16
17-19
Other (please specify)
*
4.
Please tell us your location:
(Required.)
QLD
NSW
VIC
SA
WA
ACT
NT
TAS
Other (please specify)
*
5.
If you are selected as one of our Mums Lounge reviewers, you will be required to provide us with feedback on the Modibodi products you receive that will be published and agree to a list of terms and conditions that will be provided upon selection. Do you agree to do so if you are selected?
(Required.)
Yes
No
