Intro Section

Plaza Research Chicago is conducting a study for males and females ages 21-55. This study will be held online, between July 8 and July 17. If you qualify and participate, you will receive a cash incentive.

If you're interested please fill out the questions below.

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.

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* 2. Alternate Contact number

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* 3. What is your date of birth?