MotivAider Registration

Thanks very much for purchasing the MotivAider and for taking the time to register.

If you haven't already done so, please consider joining one of our mailing lists so we can send you occasional updates, announcements and technique tips. If you're working with children, please join our Help Kids Change list. Otherwise, join our MotivAider User list.

We are fiercely committed to helping MotivAider users achieve their goals! If you ever have any questions or need any assistance, please don't hesitate to contact us. You can call us toll-free at 1-800-356-1506 (from outside North America, please call +1-218-681-6033) or email us.

Best regards,

Behavioral Dynamics, Inc.

1.

Rest assured that we take your privacy seriously. Any informaiton you choose to share with us will be used exclusively to help us better understand the needs and preferences of MotivAider users.

Name

Address 1

Address 2

City

State

Postal Code

Country

Email Address

Daytime phone

2.

If you're willing to share, we'd like to know...

Your occupation

Your gender

Your approximate age

* 3.

What is the approximate day, month and year when you purchased the MotivAider?


* 4.

Who did you purchase the MotivAider from?

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5.

How did you learn about the MotivAider?

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Other, Please enter
6.

Please check all of the purposes for which you have used or expect to use the MotivAider. Please use the Other box to tell us more about how you're using the MotivAider.

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Other, Please enter
7.

How likely are you to recommend the MotivAider to others?

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8.

If you have any questions, comments, suggestions, or requests, please enter them here. Thanks again for registering, and please remember, if you ever need assistance, we're ready to help.