-Subscription/Sample Request  
Nearer Nature bodycare range brings to the forefront beauty traditions for achieving and sustaining stronger skin, clearer complexions, healthier hair.

We use natural resources such as oils, minerals, botanical extracts etc., and influenced by age old formulas and methods carried out by civilisations around the world. We have looked towards the African, European and Pacific regions to name a few, to create simplfied and beneficial personal care products.

Simply enter your details below and you'll soon be receiving all the latest news from Nearer Nature. Be assured that we will not share your information with any companies outside of our parent company, AFV Group (UK), for marketing purposes. You will be able to unsubscribe from this mailing list at any time as described in the emails we will send you.

General Information
All information required unless otherwise stated.

Title: Mr / Mrs / Miss
Full Name:
Address: (include postcode/zipcode and country)
Email:
Ethnicity:


Age:
Known Allergies:


Samples
We may from time to time offer free samples. We need to know a little information about you so we can let you know of Nearer Nature products which you may find beneficial for your hair and skin condition. Any samples sent will be delivered to the address submitted above. Sorry – only one sample per household**


Your Skin
How would you describe your skin tone?



How would you describe your skin condition?
(Please insert an 'X' to those which apply)

Oily Dry / Oily Combo
Sensitive Dry / Very Dry
Flaky Uneven Complexion
Acne Scars / Burns
Psoriasis Stretchmarks
Eczema Contact Dermatitis



Which parts of your body are affected by adverse skin condition(s)? (Please insert an 'X' to those which apply)

Face / Neck Hands / Arms
Legs / Feet Rest Of Body



Do you currently use any of the following brands to treat this? (Please insert an 'X' to those which apply)

Balneum Boots Own Brand
Dove E45
Eucerin Neutrogena
Nivea Oil Of Olay
Oilatum Vaseline

If other, please state:



How often do you normally moisturise your skin? (eg. Never / Daily / Weekly / Occassionally)


When is your skin condition most likely to flare up? (Please insert an 'X' to those which apply)

Spring Summer
Autumn Winter
All Year  



Your Hair
How would you best describe the condition of your hair? (Please insert an 'X' to those which apply)

Thick Fine
Weak / Brittle Dry
Normal Oily
Coloured Permed
Dry Scalp Oily Scalp

Add any additional information regarding your skin and hair here:

Thank you for your input. Now submit this form to be included in our mailing list.

If you should recieve a sample, we would greatly appreciate your feedback on the product sample.**




Note: Samples can only be sent to UK residents.
** By submitting this form you give the right for us to publish your comments on products sold by Nearer Nature.