MOOSE LIGHT

First Name: *

Last Name: *

Address: *

City: *

Province: *

Postal Code: *

Home Phone Number:

E-mail Address: *

SMS/Text Message Enabled Phone:

Language Preference: *

English French

Gender: *

M F

When were you born? *

Day (DD)

Month (MM)

Year (YYYY)

What brand of beer do you drink most often? (Be honest!)

Name two other brands that you drink occassionally

How many beers do you usually drink a week?

Of the last 36 beers you drank at home, approximately how many were the beer you drink most often?

Please tell us what other alcoholic beverage(s) you drink:

Wine: glasses/week
Liquor: glasses/week
Coolers: bottles/week

Check your top 3 favourite activities:

Listening to music:
Pop
Rock
Jazz/Blues
Country
Urban / Hip-hop

Reading:
Books
Magazines
Newspaper

Participating in or watching:
Hockey
Baseball
Snowboarding/Skiing
Golfing
Hunting
Fishing
Snowmobiling
Curling
Soccer
Auto Racing
Football
Video Games
Fitness
Basketball
Home Improvements / Do-it-yourself Projects

Please enter the UPC code from the top of your beer case or the side of your can (a Moose LIGHTproduct, of course! ) ex. 7 7600000133 3

Moosehead’s Privacy Statement
The information you share with us helps us to understand your needs and preferences. That way, we can serve you even better in the future. We appreciate your privacy and guarantee that what you tell us remains between us. We’ll make sure that the information you give us is confidential and will only be used with your permission by Moosehead Breweries Limited.

Please check here if you would prefer that we not communicate with you in the future.

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