Consumer Panel Application Form - Mead Panel

1. Are you available to attend the consumer panel on Mead (contains alcohol) on Monday 28 October at the National Centre for Early Music, St Margaret’s Church, Walmgate, York, YO1 9TL? *

Yes

No

2. How often you do consume Mead? *

Fortnightly
Monthly
Every 3 months
Every 6 months
More than every 6 months

Please tick to indicate you have read, understood and accept our Declaration. *

Please tick to indicate you have read and understood our privacy statement. *

First Name *

Surname *

Date of Birth *

Phone Number *

Email *

Confirm email *

Address Line 1* *

Town/City* *

Postcode *

Please provide more information on your food allergy/intolerance

Please provide more information on your dietary requirements

Please detail the other way(s) you heard about our consumer panels

Research Centres, Institutes and Knowledge Exchange Centres

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