Mikei® Birthday Program As a special thank you for your support, Mikei® would like to commemorate your birthday with an exclusive offer. A birthday “surprise” will be customized especially for you during your birthday month, as a token of our appreciation. Simply fill out the following form or call us directly to join the “Mikei Birthday Program.” After registration, “Mikei Birthday Program” members are contacted directly for their special birthday offer prior to their birthday month. All “Mikei Birthday Program” members are eligible for Mikei birthday special offers once per year. Valid during the whole birthday month, while supplies last. Questions about the program? Call us toll-free at 1.888.606.4534 from 9am to 5pm PST, Monday to Friday. All personal information provided will not be disclosed or sold to any third parties. This offer is subject to change, alteration, or termination by Mikei at its sole discretion at any time. Email First Name Last Name Birthday / ( mm / dd ) Gender Male Female Age 18 – 29 30 – 39 40 – 49 50 – 59 60 – 64 65+ Address Address Line 2 City State/Province/Region Postal / Zip Code Country USACanada Phone Number () – (###) ###-#### Preferred Language English Cantonese Mandarin Vietnamese Preferred Method of Notification By Email By Mail By Phone How long have you been taking Mikei Reishi? Less than 1 year 1 – 3 years 3 – 5 years More than 5 years
