Charcoal BBQ Registration

1. Salutation:

Mr. Mrs. Ms. Miss

2. Name:

First Name:
Initial(s):
Surname:

3. Address:

Number:
Street:
Suburb/Town:
State/Territory:
Post Code:

4. Telephone:

Home:
Work:
Mobile:
Facsimile:

5. Email:

6. Date of Purchase:

/ /

7. Place of Purchase:

Store:
Location:

8. Purchase Price:

9. Which charcoal barbecue did you purchase?

10. Have you ever owned a barbecue before?
Yes No (If no, go to question 12)

11. What type(s) of barbecue did you own?
Weber Charcoal
Other Charcoal
Weber Gas
Other Gas

12. What influenced your purchase decision?
Renowned Weber taste and flavour
Weber quality/warranty
Demonstration/consultant
Store salesperson
Media/advertising
Internet
Recommended by a friend
Size / portability
Style / look of the barbecue
Recevied as gift
Other (please describe)

Getting to know you

We at Weber Australia encourage our customers to keep in contact so that we can exchange ideas and information about outdoor cooking and entertaining, swap recipes and keep you abreast of new innovations from Weber.
Should you wish to receive relevant information from us and become a member of the Weber Club, please answer the following questions.
The more we know about you, the more relevant the information we send you will be. However, if you feel that any of the following questions are too intrusive, just skip to the next question. Failure to answer any questions will not in any way affect your membership.

1. Gender: Male Female

2. Age Bracket:
under 20 years	20-29 years
30-39 years	40-49 years
50-59 years	60+ years

3. Marital Status: Single Married Other

4. Children living with you:
No. of children ...	under 12 years old:
	12 to 15 years old:
	over 15 years old:

5. Work Status:
Self-employed	Professional
Clerical	"Blue Collar"
Tradesperson	Retired/Semi-retired
Other

6. About your residence:
Flat, home unit or apartment	Town-house or villa
2 bedroom house	3 bedroom house
4 or more bedroom house	Other

7. How would you prefer us to send you information?
by Email by Post by Fax

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