問卷送贈品
分店 Store
(273) CY 太古城
First choice
Second choice
Third choice
日期 Date
登記成為會員？
Join as member?
是 Yes
是 Yes
是 Yes
否 No
手提號碼 Mobile No.
SMS 驗證碼 Verification Code
名稱 First Name
姓氏 Last Name
性別 Gender
是 Yes
男 Male
是 Yes
女 Female
曾經有否購買G-NiiB 產品? 如有，請選擇
Have you ever purchased G-NiiB products? If yes, please select
是 Yes
有 Yes
是 Yes
否 No
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G-NiiB 免疫+ 配方 SIM01
G-NiiB Immunity+ Formula SIM01
Checkbox
G-NiiB 免疫卓越配方 SIM01
G-NiiB Immunity Elite Formula SIM01
Checkbox
G-NiiB 免疫卓越配方 SIM01
G-NiiB Immunity Elite Formula SIM01
Checkbox
G-NiiB 免疫卓越配方 SIM01
G-NiiB Immunity Elite Formula SIM01
媒體廣告 Media Advertisement
Checkbox
電視廣告
TV Ad
Checkbox
電台
Radio
Checkbox
報章
Newspaper
Checkbox
雜誌
Magazine
Checkbox
地鐵
Train
Checkbox
網上
Online
Checkbox
其他 Other
推介 Anyone Recommends G-NiiB products to you?
Checkbox
家屬
Family
Checkbox
朋友
Friends
Checkbox
醫生
Doctors
過去半年有沒有服用其他保健產品的習慣?
Have you had the habit of taking other health products in the past six months?
是 Yes
有 Yes
是 Yes
否 No
年齡組別 Age Group
是 Yes
1 - 15
是 Yes
16 - 25
是 Yes
26 - 35
是 Yes
36 - 45
是 Yes
46 - 55
是 Yes
56 - 65
是 Yes
66 - 75
是 Yes
76 - 85
是 Yes
86+
閣下所提供的資料將用作會員服務部門行政的有關事宜。本部門或會將閣下的部分資料給予本會授權接收的其他部門使用，以便進行有推廣/會員活動。
The information you provide will be used for administrative matters related to the member services department.This department may provide some of your information to other departments authorized by the Association to use it for promotional/membership activities.
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我已閱讀並同意以上的條款。
I have read and agreed to the above terms and conditions.
已選購的產品 Purchased Product
G-NiiB 免疫卓越配方 SIM01 (28天裝)
G-NiiB 兒童免疫配方 SIM03 (28天裝)
G-NiiB M3XTRA 護腸配方 SMT04 (28天裝)
G-NiiB 免疫+ 配方 SIM01 (28天裝)
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