STOKKE® U.S.

Email:

First Name:

Last Name:

Phone Number:

Address:

City:

State:

Zip:

Mom's Group

Event Code

Number of children:

Child 1 Age

Year(s) Month(s) Week(s)

Child 2 Age

Year(s) Month(s) Week(s)

Child 3 Age

Year(s) Month(s) Week(s)

Child 4 Age

Year(s) Month(s) Week(s)

Child 5 Age

Year(s) Month(s) Week(s)

Are you expecting?

No Yes

If you are expecting,
please enter your due date:

/ /

Have you created a baby registry?

Yes
No, not yet, but plan to
No, not plan to

Registry store(s)

What Baby/Pregnancy Magazines do you read? Select all that apply

Other Magazine Name:

What Baby/Pregnancy websites do you visit? Select all the apply

Other Website Name:

I would like to receive periodic e-mails from STOKKE^® on special promotions, new product launches, or company news.