* 1. Declaration of Consent

You have been invited to participate in a questionnaire study on your memories of, and reactions to, the results of the 2012 American Presidential election.

The study is expected to take about 15 minutes, but it varies from person to person. We do not expect that you will experience discomfort or inconvenience due to your participation in the study, but, as your participation is voluntary, you are free to withdraw from it at any time

We plan to present the results of this research at professional conferences and to publish it in professional journals. In all presentations and publications, the information will be given in such a way that you cannot be identified.

This research is being conducted by Jonathan Koppel, Ph.D., postdoctoral fellow at the Center for Autobiographical Memory research at Aarhus University, Denmark. If you have any questions please email Jonathan at jkoppel@psy.au.dk, or call +45 2285 7758.

The study has been explained to my satisfaction and my participation in the survey is voluntary

* 2. Date:

* 3. To ensure that your responses will remain confidential and anonymous, we would like to assign an identification code to your questionnaire. We will not keep records that link your code to your name. We will only use this code to match your responses at this survey with those you may prove at a follow-up survey.

The identification code is the FIRST THREE LETTERS OF YOUR MOTHER’S MAIDEN NAME (EXAMPLE: SMITH = SMI). The second part of the code is the FIRST THREE LETTERS OF THE MONTH IN WHICH YOU WERE BORN (EXAMPLE: DECEMBER = DEC). This person's ID code, therefore, would be SMI-DEC.

Your ID code: