First Name*	Initial
Last Name*	Age*
Gender*	Male Female
Address*
City*
Province*	* * * S E L E C T * * * Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Territory
Postal Code*
Phone*
Email*

Do you own any of the following?
Computer	DVD Player
DVD Recorder	Cell Phone
VCR	Camcorder
Digital Camera	iPod or MP3 Player
Blackberry/PDA
Have you ever purchased any of the following Maxell products?
DVDs	CDs
Headphones	Batteries
iPod Accessories	Camcorder DVD
USB Drives	Camcorder Tape
Memory Cards
Accessories cleaners/adapters/repair kits

Comments:

Where is your favourite place to buy Maxell products?

Where did you hear about this contest?
Internet	Magazine	Event
Maxell Website	Friend	Other:

Skill Testing Question*: (12 x 3) - 4 + 12 =

I would like to receive information on new Maxell products and special promotions via email.

Maxell Canada reserves the right to qualify or disqualify any applicant that has submitted false, misleading or incomplete information. Information collected is for sole use of Maxell Canada and it's affiliates for the purpose of executing this promotion. For more information on data collected please review our privacy policy. Please review the Rules and Regulations before submitting this entry form.