Fisher-Price™ Music Sweepstakes Entry Form

Please enter your age here

Thank You for your interest in the Fisher-Price™ Music Sweepstakes.

As stated in the Music Sweepstakes Rules & Regulations, only persons who have reached the age of majority in their State or Province of residence are eligible to participate in this Music Sweepstakes.

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Thank you. Please proceed to complete entry form.

All ** fields must be completed for your entry to be submitted.

Product Information (optional)

SKU#:	096741	(last 6 digits) See Sample
Did you receive this as a gift? No Yes
Retailer:	--None-- Target Walmart Toy R' Us Babies R' Us Walgreens Shopper's Drug Mart Sears Kmart Meijer Amazon iTunes Hallmark Seaworld Baby Depot Buy Buy Baby Fred Meyers Brookstone Kohl's Costco Loblaw's Scholar's Choice Fisher-Price Toy Store Raley's Gift Shop Other (specify)	Specify:

Contact Information

**First Name		**Last Name
**Address 1		Apt #
Address 2		**City
**Country	USA Canada	**Province **State
**Zip/Postal
Your information will not be shared or sold to third parties (other than the sweepstakes administrators) for any purpose without your express permission. Please provide your E-mail and phone number so we may contact you if you are a winner.
**E-mail		yourname@provider.com
**Phone		(10 digits - no dashes)

Preferences

	Keep me informed of new releases
	Catalogue: Receive our twice a year catalogue in the mail (Free!)
	Music Feedback Panel: We love creating music and hope you will consider joining our music panel. Your time commitment would be minimal. An invitation will be sent via E-mail if we are conducting surveys or focus groups in your area.

Have you Purchased Fisher-Price™ Music or DVD products in the past?	No Yes
Child Birthday (If you want to receive offers on your child's birthday):	Day Month Year
Is this your first baby?	Yes No
How many other children do you have? --None-- 1 2 3 4 5 6 7 8 9 10

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**I have read the official Rules & Regulations.

If you have any problems submitting your entry, please contact sweepstakes@fisher-pricemusic.com.