Test Pilot Form

Dynajin Test Pilot Interest

Please complete the information below. Click “submit” to send the completed form for review.

All information must be filled out.

First Name

Last Name

Phone

Sex

Age

Birthday

List the activities you participate in regularly? And how many times per week?

Activity 1

Per Week

Activity 2

Per Week

Activity 3

Per Week

Activity 4

Per Week

Activity 5

Per Week

Social Media - List all of your social media platforms & your handle (or @).

Platform 1

Handle 1

Platform 2

Handle 2

Platform 3

Handle 3

Platform 4

Handle 4

Platform 5

Handle 5

Are you an influencer, ambassador, brand representative, or spokesperson for any company based on your social media presence or involvement in any activities or sports listed above?

Yes No

If YES, please list all affiliations (paid and unpaid)

Company 1

Website

Company 2

Website

Company 3

Website

Company 4

Website

Are you under a physician's care for, or have any allergies or known adverse reactions to any common supplements, ingredients, compounds, fruit or nut extracts?

Yes No

How did you hear about the Dynajin Test Pilot Program?

If you are selected to participate in the testing program, are you available to do so for approximately the next six months?

Yes No

Send a headshot shot of you in action! (or a selfie)

Dynajin Test Pilot Interest​

Right On!

Dynajin Test Pilot Interest