12219BEVERAGES

Thanks for your interest in this study!

MForce Research is looking for men and women to participate in a paid consumer market research study regarding beverages. The 2 hour groups interviews are taking place on Monday April, 15th. The interviews will be held at a facility in downtown Chicago, near the corner of Michigan & Wacker.

Selected participants will receive compensation of $125 on a prepaid visa for their participation in the study.

If you are interested, please fill out the following brief survey and we will call to recruit you if you appear to qualify!

Question Title

* 1. About You.

Full Name

Exact Age

Daytime Phone Number

Email Address

Zip Code of primary residence

Question Title

* 2. What is your gender?

Male

Female

A gender not listed here

Question Title

* 3. Which age bracket do you fall under

Under 21

21 - 22

23 - 39

30 - 39

40 - 45

46+

Question Title

* 4. What is the highest level of education you have completed?

Some high school or less

High school graduate

Some college

4 year college graduate

Post graduate or higher

Question Title

* 5. Which of the following best describes your current employment?

Employed full-time outside of the home

Employed part-time outside of the home

Work from home full time

Work from home part time

Stay-at-home parent/ homemaker

Currently unemployed

Student

Retired

Question Title

* 6. Which of the following best describes your annual Household income before taxes:

Less than $25,000

$25,000 to $39,000

$40,000 to $74,000

$75,000-$99,000

$100,000 or more

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* 7. What is your current marital status?

Married

Single

Divorced

Widowed

Question Title

* 8. Would you tell me please which one of the following best describes your ethnic background?

Caucasian

African-American

Asian/Pacific Islander

Hispanic or Latino

Other (please specify)

Question Title

* 9. Are you...?

Have any food allergies or sensitives

Have any beverage allergies or sensitives

Have any other medical or personal dietary restrictions

Currently suffering from a sinus or nasal condition affecting your ability to taste

Currently pregnant

Are a smoker

Uninterested in trying a new alcoholic beverage at a focus group

None of the above