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We are currently looking for Moms interested in joining the Coppertone® Water MOMS group. We are looking for moms who are passionate about sun safety and who interact frequently with other moms and their children. If you are interested in being a part of this group, please fill in the fields and answer the questions below. Please note that your information will be kept confidential and will not be shared or used for any other purpose, beyond this program.

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* 1. Contact Information

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* 2. Blog URL

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* 3. Twitter Id:

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* 4. Approximately how many moms do you communicate with OFFLINE on a weekly basis? (through school, PTA/PTO, moms groups, etc.)

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* 5. Approximately how many moms do you communicate with ONLINE (through facebook, twitter, your blog, etc.) a weekly basis?

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* 6. Number of visitors to your blog per month:

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* 7. Number of "Followers" you have on Twitter:

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* 8. Number of "Friends" you have on Facebook:

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* 9. Number of "Followers" you have on Google Friends Connect:

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* 10. Please tell us about any other ways you connect with Moms. (Example: Playgroup and meet 30-40 moms each week or month; Write for a parenting publication that reaches 30K families each month etc.)

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* 11. Please indicate which of the following positions/titles that you hold and/or participate in. Please select all that apply:

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* 12. Please provide the sex and age of each your children.

  Under 1 years 1-2 3-4 5-6 7-8 9-10 11-12 13 and older
Boy
Girl

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* 13. How often would you say that you and your family are out in the sun during the Spring and Summer months?

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* 14. Please briefly describe your standard outside activities. (Example: go to the park, swim in the pool, vacation to the beach, etc.)

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* 15. During the Spring and Summer months, how often do your kids wear sunscreen?

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* 16. During the Spring and Summer months, how often do you use sunscreen yourself?

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* 17. Besides sunscreen, what other sun precautions are part of your sun protection routine for your children? Please select all that apply.

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* 18. Please indicate your level of agreement with the following statements, by ranking each one on a scale of 1 to 7, with 1 being completely disagree and 7 being completely agree.

  1 2 3 4 5 6 7
"I avoid the sun as much as possible"
"I still don’t feel safe being out in the sun, even with sunscreen on"
"I think I look my best when I have a tan"
"Sun risks are totally blown out of proportion, it’s really not that bad"
"I worry about getting wrinkles and other signs of old age from the sun"
"...I still think it’s healthy to get some sun"
"I don't think about wearing sunscreen unless I'm out all day during the summer, or on vacation or something"
"I use the highest SPF I can find"
"I have a routine/ritual when it comes to applying my sunscreen"
"Wearing sunscreen gives me the freedom to do what I want outdoors"

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* 19. Which sunscreen brands do you use? Please select all that apply.

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* 20. To what particular brand of sunscreen are you loyal to for your children?

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* 21. To what particular brand of sunscreen are you loyal to for yourself?

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* 22. Which of the following Coppertone products have you used? Please select all that apply.

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* 23. Would you be interested in contributing any of the following to an online community for Moms on sun protection?

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* 24. When it comes to sun care, would you consider yourself an “expert” within your circle of Moms?

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* 25. How often do you speak to other Moms about sun protection?

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