17818ALCOHOL

Thanks for your interest in this study!

MFORCE Research is looking for men to participate in a paid consumer market research study regarding Alcohol. The study consists of a 30 minute, one-on-one interview and compensation is $85 on a prepaid Visa.

The interviews will be held in the afternoons and evenings of Monday and Tuesday, December 17 & 18th at a facility in downtown Chicago, near the corner of Michigan & Wacker, where free parking is provided on-site.

Please fill out the survey below. A recruiter will call you with some follow-up questions if it appears that we can place you in the study.

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

21-24

25-29

30-35

36-40

41-45

46-50

51-55

56+

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:

$29,999 or less

$30,000 - $39,999

$40,000 – $49,999

$50,000 – $79,999

$80,000 – $99,999

$100,000 or more

Question Title

* 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)