Houston Study Candy February 2019

Introduction Section

Plaza Research Houston is conducting a study with Mothers and kids on the topic of Candy! The discussion takes place on Monday February 11th, Tuesday, February 12th and Wednesday, February 13th, 2019 time varies throughout the day and evening. If you and your child qualify, and are chosen to participate, your child will receive $100 for 2 hours of their time and you would receive $150 for 3 hours of your time. (Groups are for Moms Only or Kids Only).

**Proof may be required in order to participate if chosen**

**Our Denver Office will be recruiting for this study**

Please answer the questions below. If you look like a match, we will contact you by telephone.

**Due to the large response to our surveys, we are only able to contact those that look like a match. Please continue to answer future studies, as you may be a match to those.

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* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

First Name *

Last Name *

City/Town

Email Address: *

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* 2. What is your Zip Code?

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* 3. What is your primary phone number?

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* 4. Alternate Contact number

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* 5. What is your age?

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* 6. What is your date of birth?

Date

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* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

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* 2. What is your Zip Code?

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* 3. What is your primary phone number?

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* 4. Alternate Contact number

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* 5. What is your age?

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* 6. What is your date of birth?

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* 7. What is your gender?