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Mom and Baby Products
           
 
Become a Product Tester
 
As an Evaluator, you will receive free products in exchange for your opinion on the appeal and quality of the items.
The products are yours to keep. Your name and contact information is confidential and is not shared with our
manufacturers.
 
Please note that completing this form does not guarantee that you will receive product, as we have tens of
thousands of evaluators registered. We work diligently to fairly assign product to as many new testers as
possible. Once you have signed up you will begin receiving our exciting PTPA Media Announcement emails
emails and newsletters. As a member of PTPA Media you will enjoy; coupon offers from several of our winning
companies as well a chance to enter PTPA Mom Panel for fabulous product giveaways!
 
 
 
 Basic Information  
 Name    *
 Address   *
 City    *
 Province/State  *
  Country   *
 Postal Code/Zip Code   *
 Phone    *
   
 Email Address   *
The email address will be used as your user name
   
 Mailing List  
 Join Mailing List  
   
 Role
Application
 
 Which of these Family Pets do you current own?
 Number of Children   *
 Year of Birth(s)
Child 1 Child 2 Child 3 Child 4 Child 5
Child's Sex
Child 1 Child 2 Child 3 Child 4 Child 5
 Expecting Child    Month    Year    please insert month and year
 Allergies within the home  
 Any products that you would prefer not to test?  
How did you find us   *
   
Do you agree? I have read and agree to the Waiver
   
 
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