Register to win a free one month supply of Estromineral (Monthly drawing).

Please fill in the form below. All fields marked with an * are required.
Incomplete forms will not be processed.

*Name:
Company Name:
*Address:
*City:
*State:
*Zip:
*Phone:
*Email:
*How did you hear about the contest?
Friend
Internet
Hospital
Doctor's Office
Newspaper
Magazine
Other (Please List)
*Have you ever taken a supplement product as an alternative to HRT (hormone replacement therapy)?
Yes No
*Have you experienced any of these symptoms of menopause?
Hot Flashes
Night Sweats
Palpitations
Mood Swings
Insomnia
Other
Please check all that apply.
*Would you be willing to try a new product that is a soy supplement that naturally replaces estrogens?
Yes No
*Do you think the ingredient of lactobacillus for enhanced absorption and improved digestion is important in a soy supplement product?
Yes No
*Have you ever taken any of the following nutritional supplements?
Please check all that apply.

Calcium
Glucosamine
Vitamin E
Vitamin C
Other (Please List)

*Do you use feminine hygiene products?
Yes No




Rules and Regulations:  Void where prohibited.  Rotta Pharmaceuticals and Estromineral are not responsible for errors in submissions.  Winner will be randomly drawn from all received entries.  No purchase necessary.  You need not be present to win.  Decision of judges is final only after validation.  Prize must be claimed within 30 days of reward.  Contest is open to those age 18 and older.  Employees (and their families) of Rotta Pharmaceuticals are ineligible to participate.    


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