Enrollment Method Web How did you hear about Liz Rewards? Liz Outlet Store Direct Mail Friend or Family Website Unknown Other *First Name MI *Last Name *Address Line 1 Address Line 2 Country Canada USA *City *State/Province *Zip AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY -- AB BC MB NB NL NS NT NU ON PE QC SK YT *Phone ( ) -  I choose NOT to receive promotional phone calls from Liz Claiborne. *I am a resident of the United States, Puerto Rico, or Canada. *I have read and agree to the Terms and Conditions of the Liz Rewards program.

Email I choose NOT to receive special email offers from Liz Rewards. I understand that I may still receive electronic statements and program announcements related to my Liz Rewards membership.

Gender - Select - Male Female Birthday - Month - January February March April May June July August September October November December - Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Year - 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 I shop at Liz Claiborne Outlet Stores about 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 or more times per year. (All items marked with * need to be complete for enrollment.)

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