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Thanks for requesting more information to determine your eligibility for participation in one of our current Nutritional Pilot Surveys. Please choose the most appropriate condition listed below to begin the process.

If your condition is not listed, please choose the "Other" selection and let us know what it is. If you generally have good health but still want to participate, please select "Improve my Health".
Completion of the Intial and 6 monthly Evaluation Forms is necessary to receive Matched Funding. Completing these forms will be vital for the ongoing reasearch that we are undertaking.

Applicant Information

Fill in the information below to determine eligibility in our current Pilot Surveys.
Please select all conditions that apply *
Shipping Destination *

I have read and understand the "What is the Matching Funds" information. Click Here to Review. *
I understand that by completing this Online Registration Form, I will be eligible to participate in any Pilot Survey lasting for a period of six months and will receive 2 for 1 product when ordering. *
I understand that all Participants are required to complete Forms 1 through 7 to qualify for the 2 for 1 special pricing. I also understand that if my Forms are not returned, I do not qualify for the Pilot Survey 2 for 1 special price. In which case, I agree to pay the regular price for all product received. *
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