Participant Sign-up Survey

Thank you for your interest in participating in PAID market research studies with Eastcoast Research.

Please fill out this survey so we may learn more about you. The more questions you answer, the better we can match you with project opportunities.

The information submitted is strictly confidential. Under no circumstances will your information be sold or solicited to third parties. There will be no attempt to sell products or services to you based on your participation in our studies.

Shortly after you complete this survey, one of our recruiters will call you to complete your profile and discuss upcoming participation opportunities.

You may call our Raleigh office for more information 919-444-6143.

1.Please provide the following information so we may contact you about different studies.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.What is your Age

3.Please enter your date of birth. (MM/DD/YY)(Required.)

4.What is your gender?

Female

Male

Prefer to self identify

5.Do you consider yourself part of the LGBTQIA+ community

Yes

7.Which of the following best describes your race or ethnic heritage?

Other (please specify)

8.Do you or anyone in your household speak Spanish fluently?

Yes

9.What is your highest level of education you have completed?

11.Please enter your current occupation and Employer's Name

12.What is your household annual income before taxes?

13.Do You have any children under the age of 18?

Yes