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

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

*3.Have you or any other member of your household EVER been employed by, or retired from, any of the following industries?(Required.)

An automobile dealer, leasing or rental agency

An automobile manufacturer or automotive supplier

An automobile repair or service station

A marketing research firm

An advertising or public relations agency

A newspaper, magazine, radio, or television media

An internet publishing firm

None of the above

*4.Are you currently working?(Required.)

Full-time

Part-time

Unemployed / Laid off

Retired

Homemaker

Student

*5.Please provide your employment information. If not currently employed please indicate your partner's information or your previous employment details:(Required.)

Job Title

Company

Industry

*6.What is your current role at your job?(Required.)

Owner/co-owner

Skilled worker/tradesperson

Manager/management

None of the above/Other