Survey

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.

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?

Taste Panellist Recruitment Form