SurveyMonkey Powered Online Survey

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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.

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

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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3. In which county do you live? (Required.)

Orange County

Los Angeles County

Riverside County

Ventura County

Other

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4. Are you at least 21 years of age or older? (Required.)

Yes

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5. Are you a U.S. citizen? (Required.)

Yes

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6. Are you currently registered to vote? (Required.)

Yes

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7. Do you have a valid California driver’s license or identification card? (Required.)

Yes

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8. Have you ever been convicted of a felony? (Required.)

Yes

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

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* 3. In which county do you live? (Required.)

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* 4. Are you at least 21 years of age or older? (Required.)

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* 5. Are you a U.S. citizen? (Required.)

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* 6. Are you currently registered to vote? (Required.)

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* 7. Do you have a valid California driver’s license or identification card? (Required.)

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* 8. Have you ever been convicted of a felony? (Required.)

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

3. In which county do you live? (Required.)

4. Are you at least 21 years of age or older? (Required.)

5. Are you a U.S. citizen? (Required.)

6. Are you currently registered to vote? (Required.)

7. Do you have a valid California driver’s license or identification card? (Required.)

8. Have you ever been convicted of a felony? (Required.)