*1.This survey is being conducted by Adler Weiner Research in order to determine your eligibility for a focus group or interview about which you have been contacted. At no point are your individual answers ever sold or shared with our clients (aggregate data or anonymized summaries of the overall survey information may possibly be shared with our clients, however). This survey serves solely as a means for screening. Once the project has been completed this data will be deleted.  For more information please see:
Right to Opt-Out Info
Financial Incentive Info
Adler Weiner Privacy Policy(Required.)

I consent to Adler Weiner Research collecting, storing and processing my personal information for the purpose of determining my eligibility for this market research focus group or interview.

I understand and consent to the following: That should I be eligible for participation in this market research focus group or interview, my contact information (phone, email, and home address) may be shared with the client for purposes related only to this particular project and are not limited to: screening calls to further determine eligibility, sending of "homework" or pre-session assignments via email, allowing access to an online platform via email, or for in-home interviews conducted at your residence.

2.By proceeding, you certify that all answers provided in this application are truthful, accurate, and complete to the best of your knowledge. You also confirm that you have completed this application independently, without the assistance of AI tools, chatbots, or other external aids.

Please note: The client reserves the right to disqualify and turn away any participant without compensation if any information provided is found to be untruthful, inaccurate, or generated by AI.

Do you agree with the conditions above?

Yes

No

*3.CONTACT INFO Please provide the following:(Required.)

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

4.Approximately how long does it take you to travel from your home to LOS ANGELES: WESTFIELD FASHION SQUARE (Sherman Oaks)

Less than 10 minutes

10-15 minutes

16-20 minutes

21-30 minutes

31-45 minutes

More than 45 minutes

5.What gender do you identify as?

Male

Female

Non-Binary

Other (please specify)

6.What age range do you fall into?

Under 18

18-24

25-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70+

7.What is your exact age?

8.When was the last time that you participated in a marketing research study? Would that be…

In the past 6 months

7-12 months ago

More than 12 months ago

Never

9.Are you currently scheduled to participate in any marketing research studies at Adler Weiner or any other company, or not?

Yes

No

10.What is your current employment status?

A full-time employee

Working part-time

Laid-off/looking for work

A stay-at-home parent

Retired

Current student either part-time or full-time

I have my own side business, for example, selling homemade jewelry, paid handy-man projects, etc.

11.Are you or is any member of your household currently employed by, previously employed by, or retired from any of the following types of industries?

An advertising agency or market research firm, marketing firm or marketing department in your own firm

A public relations company

By the news media, such as television, radio or a newspaper

A journalism company or as a blogger/journalist

As an employee or related to any employee of a clothing manufacturer, distributor or retail store

None of the above

*12.Please provide your employment information. If not currently employed please indicate your previous employment details:(Required.)

Job Title

Company

Industry