Sign Up - KGL Skin Study Center

First Name*
Last Name*
Race
Gender
Birth Day* mm/dd/yyyy
Phone*
City
Address
State
Zip Code
Email*
Contact Method
Have you previously participated in a KGL study?
Eye Color
Hair Color
I have/had one or more of the following conditions:
Facial freckles, age spots, or uneven pigment
Crow’s feet lines
Undereye lines
Facial wrinkles
Acne
Rosacea
Psoriasis
Dry or sensitive skin
Eczema, atopic dermatitis, or allergies
My complexion is (chose one):
Fair – always burns, never tans (Caucasian)
Fair – burns easily, barely tans (Caucasian)
Medium - can burn, tans well (Caucasian)
Medium - seldom burns, tans very well (Mediterranean, Hispanic)
Dark - rarely burns, tans easily (Asian, Native American, African American)
Dark - rarely burns, deeply pigmented (African American)
Verification	3 × 5 = ?