Register Chia Seeds Step 1 of 2 50% Salutation*MrMrsMsName* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Age Ch-Ch-Ch-Chia Chia Seeds were*Received as a giftPurchased myselfIf received as a gift, purchaser is*MaleFemaleNo answerHave you bought Chia seeds before?*YesNoWhere did you buy them?*How much do you usually buy at one time?*Less than 1 lb.1 lb.1.5 lb.2 lbs.3 lbs. or moreHow many members of your household consume Chia seeds?*1234more than 4How long have you been eating them?*Less than 1 month2-12 months1-3 years3-5 yearsMore than 5 yearsHow do you like to eat your Chia seeds?*Mixed into drink/shakeSprinkled on saladAdded to yogurtOtherWould you be interested in a 12-month membership for a regular supply (1 bag per month)?*YesNoMaybeHow did you hear about Ch-Ch-Ch-Chia Chia Seeds? Check any that apply* TV Radio Newspaper/Print Website/Online Friend/Family member Other If other, please specify.*What aspect(s) of Ch-Ch-Ch-Chia®Chia Seeds appeal to you most? Check any that apply.* Qualify brand Potential health benefits Taste Easy to digest Other If other, please specify.*Part of Joseph Enterprises' ongoing commitment to quality is to stay in touch with our customers. Best way to contact me is*EmailPhoneNo answerEmail* Phone*Additional comments PhoneThis field is for validation purposes and should be left unchanged.