Other Countries

FreshKon® Club Members Registration

As a FreshKon® Club member, you will be kept informed about informative eye-care and eye-health tips, through our e-newsletter.
Please ensure that you fill in the compulsory fields (*) in this form.

Last Name* :

Gender* :  Male    Female
Age* :
Birthday* : Day     Month     Year  
Email* :
Address 1* :
Address 2 :
Country* :
Postal Code* :
Contact No* : Home
  Office
  Mobile
Occupation* :
1) Are you currently wearing color lens?       Yes   No
If yes, which brand are you using?
FreshKon®      FreshLook      Acuvue Colors
Others: please specify
2) Are you currently a FreshKon® product user?*       Yes   No
If Yes, what FreshKon® product(s) are you using?  
  Colors Fusion Solitude Alluring Eyes  
  Monthly Clear Monthly Toric Daily Clear
If No, which brand of products are you currently using?  
  Acuvue Focus Biomedics Frequency SofLens™
 
None of the above Others: please specify
3) How long have you been a contact lens wearer?    

I have read and agreed to the above Terms & Conditions.