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Become A Panelist Form

TEST SUBJECT QUALIFICATION QUESTIONNAIRE (STRICTLY CONFIDENTIAL)

Name(Required)
Gender
Are you 18 to 70 years of age?
Skin Type the best describes you:
Are you currently pregnant or breast feeding?
Are you taking, or have you taken any medications within the last 30 days that would cause you to be sensitive to sunlight?
Do you have any history of skin conditions to include: Skin Cancer, Psoriasis, Eczema, Dermatitis, Body Fungus?
Have you had any recent sun exposure on your back (shoulders to your waist) within the last month?
Have you ever had an adverse reaction to any sunscreens, drugs, or topically applied cosmetics?
Have you ever had an adverse reaction to bromine or chlorine? For example any skin irritation or rash after swimming in a pool or being in a jacuzzi (whirlpool)?
Do you have the ability to enter/exit an above ground jaccuzzi/ whirlpool without assistance?
Do you have swim trunks (males) or a bathing suit (females) that would allow access to your back, from the shoulder blades to your waist?
Are you currently participating in any other paid clinical study?
Do you have your own transportation?