Survey

New iPod Giveaway

Enter to win!
Complete this survey for a chance to win an iPod! Registrations will be accepted through December 31st, 2006 and the winner will be determined on January 15th, 2007. Winners will be notified within 30 days of the drawing. See "official sweepstakes rules" for terms and conditions. Items with an "*" are required information.

* Auth Code: (request code)

* 1. First Name

* 2. Last Name

* 3. Address

* 4. City

* 5. State

* 6. ZIP Code

* 7. Birthdate

* 8. Phone

* 9. E-mail

* 10. Bleeding disorder type

* 11. What type of provider to you use to obtain factor products?

* 12. What are four key qualities you look for in a provider?

* 13. What is the most important service your provider offers?

* 14. What would you change about your provider?

* 15. What factor product do you use?

* 16. How did you choose that product?

* 17. Are you aware of how much your current provider charges for your factor product?

* 18. What are your/loved one's major problems/concerns about living withhemophilia/bleeding disorder today?