Baby Brezza Baby Showers

1. Baby Brezza Fall Baby Shower Program

If you are hosting or co-hosting a baby shower between now and September 30, 2012, this program is for you!

Fill in the information below if you are interested in receiving a gift from Baby Brezza to present to the guest of honor.

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1. First Name (Required.)

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2. Last Name (Required.)

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3. Email Address (Required.)

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4. Street Address (No PO Boxes please) (Required.)

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5. City (Required.)

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6. State (Required.)

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7. Zip (Required.)

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8. Blog Name/URL

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9. Twitter Name (if applicable)

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10. Facebook Page

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11. Are you hosting a baby shower between now and September 30, 2012?

Yes

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12. If you have a specific date for the shower, please indicate below:

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13. Are you willing and able to send a copy of your shower invitation to be eligible for the program?

Yes

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14. Are you willing to post pictures and/or video from the baby shower event on social media channels within two weeks after the event (including Baby Brezza's Facebook Fan page, your own Facebook page, blog, etc.)?

Yes

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15. If you are selected to participate, there are several products to choose from. Please indicate your choice in order of preference (Choice 1 being the item you prefer first):

	Choice 1	Choice 2	Choice 3
QuickBlend + Accessories	QuickBlend + Accessories Choice 1	QuickBlend + Accessories Choice 2	QuickBlend + Accessories Choice 3
Temp Control Water Kettle + Perfect Measure Powder Formula Dispenser	Temp Control Water Kettle + Perfect Measure Powder Formula Dispenser Choice 1	Temp Control Water Kettle + Perfect Measure Powder Formula Dispenser Choice 2	Temp Control Water Kettle + Perfect Measure Powder Formula Dispenser Choice 3
One Step Baby Food Maker	One Step Baby Food Maker Choice 1	One Step Baby Food Maker Choice 2	One Step Baby Food Maker Choice 3

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* 1. First Name (Required.)

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* 2. Last Name (Required.)

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* 3. Email Address (Required.)

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* 4. Street Address (No PO Boxes please) (Required.)

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* 5. City (Required.)

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* 6. State (Required.)

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* 7. Zip (Required.)

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* 8. Blog Name/URL

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* 9. Twitter Name (if applicable)

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* 10. Facebook Page

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* 11. Are you hosting a baby shower between now and September 30, 2012?

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* 12. If you have a specific date for the shower, please indicate below:

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* 13. Are you willing and able to send a copy of your shower invitation to be eligible for the program?

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* 14. Are you willing to post pictures and/or video from the baby shower event on social media channels within two weeks after the event (including Baby Brezza's Facebook Fan page, your own Facebook page, blog, etc.)?

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* 15. If you are selected to participate, there are several products to choose from. Please indicate your choice in order of preference (Choice 1 being the item you prefer first):

1. First Name (Required.)

2. Last Name (Required.)

3. Email Address (Required.)

4. Street Address (No PO Boxes please) (Required.)

5. City (Required.)

6. State (Required.)

7. Zip (Required.)

8. Blog Name/URL

9. Twitter Name (if applicable)

10. Facebook Page

11. Are you hosting a baby shower between now and September 30, 2012?

12. If you have a specific date for the shower, please indicate below:

13. Are you willing and able to send a copy of your shower invitation to be eligible for the program?

14. Are you willing to post pictures and/or video from the baby shower event on social media channels within two weeks after the event (including Baby Brezza's Facebook Fan page, your own Facebook page, blog, etc.)?

15. If you are selected to participate, there are several products to choose from. Please indicate your choice in order of preference (Choice 1 being the item you prefer first):