1. Panel Member Information

This information is being collected for research purposes only. It will be kept strictly confidential.

Please enter the email address at which you would like to receive payments for the studies you complete. If you have a PayPal account, this should be the email address associated with your PayPal account.

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* 1. Please enter the email address at which you would like to receive payments for the studies you complete. If you have a PayPal account, this should be the email address associated with your PayPal account.

First Name

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* 2. First Name

Last Name

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* 3. Last Name

Address Line 1

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* 4. Address Line 1

Address Line 2

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* 5. Address Line 2

City

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* 6. City

State/Province

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* 7. State/Province

Postal Code

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* 8. Postal Code

Are you eligible to vote in the country in which you reside?

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* 11. Are you eligible to vote in the country in which you reside?

Home Phone

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* 12. Home Phone

Work Phone

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* 13. Work Phone

Gender

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* 14. Gender

Are you employed full time?

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* 25. Are you employed full time?

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