1. Your Full Name*
2. Mailing Street Address
   or P.O. Box*
3. Apt./Unit/Suite
4. City*
5. Province/State* Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories and Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon --------------------------- Alabama Alaska Arizona American Samoa Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
6. Country* Canada United States
7. Postal Code*
8. Your e-mail address*

Please answer the following questions:

Tell us how you heard about Safe-for-School WOWBUTTER*

What aspect of Safe-for-School WOWBUTTER interests you the most? *

Do you or any of your children have a peanut and/or tree nut allergy?*

Does your child's school have a peanut allergy policy that restricts or bans peanut and/or tree nut products?*

Please enter the number you see here: