First Name * Last Name * Address * City * Province * __Province Alberta British Columbia Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland Northwest Territories Nunavut Country Canada Postal Code * Gender Female Male Age 17 or younger 18-24 25-34 35-44 45-49 50-54 55-64 65+ Email * Have you tried riceworks® before? ----- Yes No What would you suggest for a new riceworks® flavor? What is your favorite snack to munch on while you surf the web? Items marked with an * are required. Yes, I would like to receive emails about special riceworks® offers and new product information.   Yes, I would like to receive an email invitation to join the My Snack Works Consumer Advisory Panel. I agree that Snack Alliance may provide my email address to Vision Critical Communications Inc. (“VCCI”), the third-party service provider providing the technology to operate the My Snack Works Consumer Advisory Panel and that VCCI may contact me at such address in order to invite me to join the Panel.