Taste Panellist Recruitment Form

The personal information collected is used to support projects conducted by the Sensory Evaluation Program.  Collection is authorized under section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act and managed and protected in accordance with the Act. Questions about the collection can be directed to the Consumer Product Testing Centre, #106, 100030 – 107 Street Edmonton AB T5J 3E4, Telephone: 780-415-6268, Email: cptc@gov.ab.ca.   

 

                                                                                                                                 

1. 

Please provide the following information.                                                                                    

First name:      Last name:

Birthdate (year/month):

E-mail address:

Home phone:    Work phone:   Cell phone:  

2. Please provide your gender.
Male  
Female  
Other  
3. Which of the following best describes your eating preference.
Non-vegetarian  
Lacto-ovo-vegetarian (eat both dairy products and eggs)  
Lacto-vegetarian (eat dairy products but not eggs)  
Ovo-vegetarian (eat eggs but not dairy products)  
Vegan (do not eat dairy products, eggs or any products of animal origin)  
Other (please describe)   
4. Please identify any allergies you may have.  Check all that apply.
None  
Nuts  
Seeds  
Eggs  
Milk  
Fish  
Shellfish  
Soy  
Wheat  
Sulphites  
Mustard  
Other (please describe)   
5. Please list any food sensitivities (e.g., lactose intolerance) you have.
 
6. Which location(s) do you prefer?  Check all that apply.
Downtown Edmonton (Seventh Street Plaza, 10030-107St.)   
Food Processing Development Centre (Leduc)  
Home Use Test  
7. How did you hear about becoming a participant?
From a friend/colleague/family member   
A sign in the building  
A newspaper advertisement   
Surfing the Web  
Other (please specify)