Enfamil Family Beginnings™

Congratulations

You're starting an incredible new chapter in your life, filled with special moments and dreams for the future.

Would you like to sign up for Enfamil Family Beginnings™ and receive:

• Free Samples, Valuable Coupons, and Special Promotions
• A Month by Month Journey Through Your Pregnancy and  Your Baby & Toddler's Development
• Expert Nutrition and Developmental Advice
• Tips on Breastfeeding, Formula  Feeding, and Starting Solids
• Support From Our Caring Team of Professionals

Enrollment Form

*Baby's due date/birth date:  MM/DD/YYYY

*Language Preference: English French

Title: Title Mrs. Miss Ms. Mr. Dr.	*Parent's First Name:	*Last Name:
Street Number:	*Street Name/PO Box/Route:	Street Type:	Unit/Suite/Apt:

*City:

*Province: Select Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador               Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

*Postal Code:

Home Phone Number: Numbers only including area code.

*Would you like to receive emails from Enfamil Family Beginnings on baby's growth and development? Yes No

E-mail Address:

*Which sample of formula do you prefer to receive? Enfamil A+® (Our closest formula to breast milk). With DHA and ARA (sources of Omega-3 and Omega-6 fats)

Enfamil® Soy A+® (soy based, milk-free formula)

No sample, please

*Which sample of formula do you prefer to receive? Enfagrow®, a nutritional supplement specifically designed to support balanced nutrition for toddlers 12-36 months

No sample, please

*Are you expecting twins? Yes No

How did you hear about the program? Surfing the web Magazine ad In a store or in a store flyer Nurse or Dietitian or Pharmacist Doctor Friend or relative Television Hospital Label on Formula Can Email

At Mead Johnson Nutrition we respect your right to privacy. The personal information you have provided will only be used by us for the purposes of fulfilling your membership in the Enfamil Family Beginnings Program. Please check this box if you would like to have your information shared with other companies that work on our behalf.

Limit one offer per household. Offer subject to change without notice. Enfamil Family Beginnings program benefits may vary. All information is kept strictly confidential. Read our privacy policy.