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Consumer Opinion Forum

To register, please fill out the form below. All fields (except certain fields which depend on number of children) are required. This form should take no more than 10 minutes to fill out. By filling out this form, you agree that you are at least 18 years old and are not a current employee of, or contractor working for, the CPSC. Your e-mail address will be used to notify you about new questions that have been posted to the Forum or about other information relevant to the Forum. Your e-mail address will not be disclosed or distributed outside the agency.
  Required Account Information          
  Email Address:*             
 (password must be 6-12 characters in length and must contain one or more letters and one or more numeric digits.)
  Password:*
  Re-enter Password:*
  Sex: *
  Zip code (current residence): *
   Date of Birth: *   (mm/dd/yyyy)  
 Child Information
  Number of Children:*
  Child 1 Sex: Date of Birth (DOB):
  Child 2 Sex: Date of Birth (DOB):
  Child 3 Sex: Date of Birth (DOB):
  Child 4 Sex: Date of Birth (DOB):
  Child 5 Sex: Date of Birth (DOB):
  


This information is collected by authority of 15 U.S.C. 2054 and will be entered into a database by a Consumer Product Safety Commission employee or contractor. No personal information will be disclosed without explicit permission. If you have any questions or comments regarding the Consumer Opinion Forum, please contact us at cof@cpsc.gov

OMB Control Number 3041-0135, expires 12/31/2009

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