2008 Chin-Up Common Cold Report Form

2008 Chin-Up Strip Common Cold Report Form

If you used Chin-Up Strips regularly during the entire year 2008, please submit your annual Common Cold Report online by answering the questions below and clicking on Submit.

You can submit your report by calling us at 1-888-835-4563, or by email or snail mail or by printing this form and faxing it to us at 1-678-482-8509. Submit your report and we will send you a free 30 pack as indicated below.

When you replace your 2008 calendar, submit your report about your common cold experience during 2008. Please keep a record of your common cold experience on your 2009 calendar.

We will send you a FREE 30 pack of the strips you use, after you send us your 2008 common cold report.

We send a free 30 pack with your next order after you send us your report. Please tell us if we ever forget to send your free 30 pack.

Please fill out the form below to submit your report:
* All Fields Are Required Unless Indicated*

1. Which type of Chin-Up Strip do you use?

Tan Boomerang (Item #33330)
Tan Horseshoe (Item #22230)
White Horseshoe (Item #11130)

2. How long have you been using Chin-Up Strips?

Less than 1 year
Longer than 1 year
Longer than 3 years
Longer than 6 years

3. On average, how often do you use a Chin-Up Strip?

7 nights per week
5 nights per week
3 nights per week

4. Do you use Breathe Right nasal strips during sleep?

Yes
No

5. Do you use a Cpap or Bipap machine?

Yes
No

6. Did you have a Common Cold during 2008?

No
One
Two
Three or more

7. Did you have a sinus infection during 2008?

Yes
No

8. During 2008, did you use a Chin-Up Strip during an airline flight?

Yes
No

9. Additional Comments: (optional)

10. Please provide Your Name, Phone Number and Email Address:

        First Name:

        Last Name:

        Phone Number:

        Email Address: (optional)