Product Dynamics, a division of RQA, Inc., has over twenty years of experience in the market research industry. Our company partners with Fortune 500 companies to assist them with product development and consumer product testing, ranging from food and beverage products to personal care items. Our state-of-the-art testing facility is located in Orland Park, Illinois. By participating in a consumer test panel, your opinions contribute to the decision-making process of our clients and may help determine the types of products that enter the marketplace.

If you are interested in becoming a panelist for Product Dynamics, please fill in the following request form.
(Fields marked with an asterisk * are required)

Product Dynamics is proud to be a member of the Homer Township Chamber of Commerce and the Orland Park Area Chamber of Commerce.

PERSONAL INFO
First Name *
Last Name *
Address
City
State
Zip
Main Phone *
Alternate Phone
Email Address
Date of Birth *	(mm/dd/yyyy)
Gender *	Male   Female
Ethnicity *	African American Asian American Caucasian
	Hispanic Native American Other/Unspecified
Marital Status	Single  Married Divorced/Separated  Widowed
Employment Status	Full-time  Part-time Student  Unemployed
Occupation	Choose One.......... Clerical Laborer/Blue Collar Management Professional Sales Self-employed Student Technical Other
Education	Choose One.......... Some High School High School Grad Some College College Graduate Post Graduate Trade School
Household Income	Choose One.......... Under $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999 $50,000-$59,999 Over $60,000
Head of Household?	Yes   No
Home Ownership	Own  Rent Live with Parents  Other
PRODUCT USE
Fast Food Restaurants Used (check all that apply)	McDonalds Burger King Wendy's KFC Taco Bell Arby's Popeye's Culver Subway
Beverages Used (check all that apply)	Bottled water Enhanced water Fruit juice Caffeinated soft drinks Enhanced sports drinks Coffee Tea Beer Wine Hard alcohol
Other Products Used (check all that apply)	Shampoo Conditioner Deodorant Anti-perspirant Mousse Gel Body lotion Body spray Foot powder Cologne Perfume After shave Deodorant soap Body wash
OTHER FAMILY
Spouse	First Name Last Name
Date of Birth
Gender	Male   Female
Ethnicity	African American Asian American Caucasian
	Hispanic Native American Other/Unspecified
Child 1	First Name Last Name
Date of Birth
Gender	Male   Female
Ethnicity	African American Asian American Caucasian
	Hispanic Native American Other/Unspecified
Child 2	First Name Last Name
Date of Birth
Gender	Male   Female
Ethnicity	African American Asian American Caucasian
	Hispanic Native American Other/Unspecified
Child 3	First Name Last Name
Date of Birth
Gender	Male   Female
Ethnicity	African American Asian American Caucasian
	Hispanic Native American Other/Unspecified
Child 4	First Name Last Name
Date of Birth
Gender	Male   Female
Ethnicity	African American Asian American Caucasian
	Hispanic Native American Other/Unspecified
How did you hear about us?	Choose One.......... Friend Web Search Engine Exposition/Show Newspaper Ad Magazine Ad Other Please Specify
* I am willing to participate in sessions conducted at Product Dynamics' Orland Park, IL facility. Yes No
* By checking this box, I agree that I have voluntarily submitted my information to Product Dynamics so I may be contacted to participate in the company's consumer research panels.
The information we collect is for internal use only. Product Dynamics will never sell or give out any personal information. Panelists will be contacted on an as-needed basis.