Thank you for taking the time to add or update your information in our database.

This information will not be released or sold to any outside party. It is for our research purposes only and will be used to contact you regarding up and coming paid focus group studies. Adding and/or updating your information will ensure you are contacted more for studies you may qualify for and less for studies you will not qualify for.

* 1. Please enter your name below

* 2. What is your phone number? (please use numbers only, no dashes)

* 3. What is your gender?

* 4. Please enter your date of birth below

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* 5. What is your ethnicity?

* 6. What is your marital status?

* 7. What is the highest level of education you completed?

* 8. What is your current employment status?

* 9. Which of the following best describes your job role?

* 10. For studies regarding community issues, what is your party affiliation?

* 11. Are you registered to vote in the state you currently reside in?

* 12. Do you do any of the following types of gambling? (select all that apply)

* 13. Do you suffer from any of the following medical conditions? (select all that apply)

* 14. Which of the following types of beverages do you drink, if any? (select all that apply)

* 15. What is your total household income before taxes?

* 16. What type of housing do you have?

* 17. _

  Yes No
Do you gamble?
Are you a vegetarian?
Do you consider yourself to be Gay or Lesbian?
Do you consider yourself to be Bi-sexual?
Do you have internet connection at home?
Do you own a dog?
Do you own a cat?
Do you wear eyeglasses?
Do you wear contacts?

* 18. Do you own a smartphone?

* 19. Do you have any children under 18?

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