SurveyMonkey Powered Online Survey

1. General Information

14% of survey complete.

Please complete the following questions so that we may contact you to participate in research studies you may be qualified for. Questions with an * require an answer.

Question Title

* 1. Please provide your contact information.

Name:

City/Town:

State:

ZIP/Postal Code:

Question Title

* 2. Best phone number to reach you at: (xxx) xxx-xxxx

Question Title

* 3. Best email address to reach you:

Question Title

* 4. Do you work in any of the following fields?

Advertising, Marketing, Market Research, Public Relations

Banking, Insurance, Financial Services

Computer Hardware, Computer Software Development

Computer Sales or Servicing

Education

Entertainment

Healthcare

Medical Supplies or Equipment

Non-profit

Other

Retail

Retired

Web Design

Other (please specify)

Question Title

* 5. In what year were you born?

Please enter 4 digit year

Question Title

* 6. What is your gender?

Male

Female

Question Title

* 7. What is your ethnicity?

Caucasian/White

African American/Black

Hispanic/Latino

Asian/Pacific Islander

American Indian/Alaskan Native

Other (please specify)

Question Title

* 8. What level of education have you completed?

Never attended school or only attended Kindergarten

1-8 (elementary)

9-11 (some high school)

12 or GED (high school graduate)

Some college or technical school

Associate's Degree

Bachelor's Degree

Master's Degree

Doctorate Degree

Advanced degree (MA, PhD, etc.)