Study Interest Form

1. Welcome

4% of survey complete.

Thank you very much for your interest in joining our consumer panel!

Your valuable opinions could contribute to creating new products, services, advertisements, and possibly sustaining the environment.

We will be asking you some background information, as well as a series of questions regarding your lifestyle and consumer packaged good preferences in order to determine your eligibility for future research studies.

All the information you provide will be kept confidential and will not be shared with any third party.

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* 1. Name (First and Last)

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* 2. Email Address

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* 3. Phone Number (XXX-XXX-XXXX)

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* 4. Gender

Male

Female

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* 1. Name (First and Last)

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* 2. Email Address

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* 3. Phone Number (XXX-XXX-XXXX)

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* 4. Gender

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* 5. Birth year (YYYY)