Appendix D -- Consent Form

Appendix D – Consent Form

Thank you for continuing to be part of the Ipsos i-Say Panel. This is a study about new consumer products. If you agree to take part in this research, you will be asked to view television advertising for a new product and answer some questions about the advertising. The study will take about 20 minutes. You will earn 90 reward points for your time and completion.

Your response to this survey, or any individual question on the survey, is completely voluntary. You can refuse to answer any question. You will not be individually identified and your responses will used for statistical purposes only. Your answers and information will be kept private to the extent allowable by law.

If you have questions about your rights as a participant in this survey, or are dissatisfied at any time with any aspect of the survey, you may contact i-Say Panel at questions@i-say.com

This research is authorized by Section 1701(a)(4) of the Public Health Service Act (42 U.S.C. 300u(a)(4)). Confidentiality protected by 5 U.S.C. 552(a) and (b) and 21 CFR part 20.

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