New Registration Please complete this questionnaire to join the ADSL Panel E-mail* Password* Confirm password*
General Information First name? * Surname? * Email Address * For exciting user trials, we will need to contact you by email. Please confirm the best email address to reach you on...* House number and street? * This is the address to which we shall send products to try when you are part of a user trial so please ensure it is a valid address for receiving these packages City * Postal/Zip Code * This is the address to which we shall send products to try when you are part of a user trial so please ensure it is a valid address for receiving these packages Country Telephone Number * In case we need to contact you by phone concerning a trial, please state your best phone number Date of Birth * Gender * Male Female Country of Birth * How would you describe your ethnicity? * Different ethnicities tend to exhibit different dermatological & hair properties Black or African-American South Asian (e.g. Indian or Pakistani or Sri Lankan) South East Asian (e.g. Japanese or Chinese or Korean) Arabic or Egyptian or Maghreb Hispanic or Latino White American Indian Alaskan Native Other Pacific Islander Mixed I prefer not to answer ethnicity How would you describe your skin type (you can select more than one) * Dry Very Dry Sensitive Combination Oily Normal Allergies Do you have any specific allergies, skin or otherwise? * Yes No Have you ever had an allergic reaction to anything? * Yes No Please enter a description below of any known or suspected allergies Medical Conditions & Health Requirements Do you wear contact lenses? * Yes No Are you on medication or do you have any other medical conditions that you suffer from? * Yes No Are you physically fit with no known issues of concern? * Yes No Do you have any medical history that precludes you from the trials? * Yes No Please can you give a list of any concerns including if you take medication for this Useful Information Marital Status Single (never married) Living with partner Married Separated Widowed Divorced I prefer not to answer status People in household One dot: , 9 dots: Most frequently used form of transport Walking Bike Motorcycle Car Bus Metro Train Airplane Highest level of education Less than High School (Secondary School) High School (Secondary School) or equivalent Attended College / University Bachelor's degree Master's degree Professional degree Doctorate degree I prefer not to answer about education Industry most involved with Approximate income level Under £20000 £20000 - £30000 £30000 - £40000 £40000 - £50000 £50000 - £75000 £75000 - £100000 £100000 - £150000 £150000+ I prefer not to answer income Monthly spend on cosmetics Under £5 £5 - £10 £10 - £20 £20 - £30 £30 - £40 £40 - £50 £50 - £100 £100+ Method of buying cosmetics Online In Store TV (e.g. QVC) Other
Products for User Trialling We are interested to know what product groups you would like to trial. Please tick as many of the following: * Body & Hand Care Colour & Makeup Care Facial Skin Care Hair Care Sun Care Deo & Depilatories Consent to being contacted with regard your registration Please confirm you consent to us contacting you with regard your registration * Yes LF Deo Yes No Barry M Yes No
