Exit this survey >> Shampoo Information 1 Question Title * 1. What is your FIRST and LAST name? Question Title * 2. What is the best phone number for us to contact you on? Question Title * 3. Email address: Question Title * 4. Home Zip code Question Title * 5. What is your gender? Male Female Question Title * 6. What is your age? Question Title * 7. Which of the following best describes your ethnic background? African American Asian Caucasian Hispanic/Latino Native American Other Question Title * 8. Which of the following best describes your marital status? Married or living with someone Single Divorced or separated Widowed Question Title * 9. Which of the following represents your completed level of formal education? Some High School or less Completed High School Some College or Technical School Completed College/Technical School Some Post-Graduate Study or more Question Title * 10. In which of the following categories does your total annual household income fall: Less than $30,000 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $74,999 $75,000 - $99,999 $100,000 or more Question Title * 11. What is your current employment status? Full-Time Homemaker Full Time Student Part Time Student Employed Part-Time Employed Full-Time Retired Currently Seeking Employment Other (please specify) Question Title * 12. What industry do you work in? Question Title * 13. What is your job title? Next >>