Tuesday, March 30, 2010
Registration Form:
MamaIceBlendz Member Registration Form
Questions marked by * are required.
1.
Name: *
2.
Date of Birth (dd/mm/yyyy) *
3.
Email: *
4.
Gender: *
Male
Female
5.
Race: *
Malay
Chinese
Indian
Others
6.
Address: *
7.
Country: *
-
Malaysia
Others
8.
Preferred Method to be Contact: *
Phone
SMS
Email
9.
Favourite Flavor: *
Chocolate
Vanilla Chocolate
Vanilla
Mocha
Cappuccino
Latte
10.
How do you know/find this blog: *
Family Member(s)
Friend(s)
Search Engine
Article
Other
Newer Post
Older Post
Home