Benchmark Panel - Registration Form
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First Name *
Last Name *
Gender *
What year were you born? (please write in full eg 1976) *
What month were you born (please select) *
Mobile or best contact number *
Mobile number is preferred as we usually contact you via sms.
Email address *
Which state do you live in? *
Who is the main grocery buyer in your household? *
Do you have any food allergies, intolerances or restrictions? *
Required
If 'Yes', please list the foods you avoid:
Which of the following locations are convenient for you to attend Taste Tests? (tick all that apply) *
Required
How many years have you lived in Australia? *
What is your cultural background? *
Do you own any pets? *
Required
Do you and/or your partner smoke?  (tick all that apply) *
Required
We conduct taste tests for children of all ages as well.  Do you have children living at home and would like to also receive notifications about taste tests for children? *
If applicable, what year was your 1st child born?
If applicable, what year was your 2nd child born?
If applicable, what year was your 3rd child born?
If applicable, what year was your 4th child born?
If applicable, what year was your 5th child born?
How did you hear about our taste test panel? *
Thank you for registering your details.  Hit the submit button below, then LIKE our facebook page (Benchmark Taste Test Panel) to keep up to date with taste tests happening in your area.
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