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1.
This survey is being conducted by Adler Weiner Research in order to determine your eligibility for a focus group or interview about which you have been contacted. At no point are your individual answers ever sold or shared with our clients (aggregate data or anonymized summaries of the overall survey information may possibly be shared with our clients, however). This survey serves solely as a means for screening. Once the project has been completed this data will be deleted. For more information please see:
Right to Opt-Out Info
Financial Incentive Info
Adler Weiner Privacy Policy
(Required.)
I consent to Adler Weiner Research collecting, storing and processing my personal information for the purpose of determining my eligibility for this market research focus group or interview.
I understand and consent to the following: That should I be eligible for participation in this market research focus group or interview, my contact information (phone, email, and home address) may be shared with the client for purposes related only to this particular project and are not limited to: screening calls to further determine eligibility, sending of "homework" or pre-session assignments via email, allowing access to an online platform via email, or for in-home interviews conducted at your residence.
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2.
CONTACT INFO
Please provide the following:
(Required.)
Name
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Address
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Apt # if applicable
City/Town
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State/Province
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ZIP/Postal Code
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Email Address
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Phone Number
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3.
By proceeding, you certify that all answers provided in this application are truthful, accurate, and complete to the best of your knowledge. You also confirm that you have completed this application independently, without the assistance of AI tools, chatbots, or other external aids.
Please note:
The client reserves the right to disqualify and turn away any participant without compensation if any information provided is found to be untruthful, inaccurate, or generated by AI.
Do you agree with the conditions above?
Yes
No
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4.
What is your gender?
(Required.)
Male
Female
Nonbinary
Prefer to self-identify
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5.
What is your current age group?
(Required.)
28 or under
29-34
35-44
45-54
55-60
61-65
over 65
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6.
What isyour exact age?
(Required.)
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7.
How would you describe yourself?
(Required.)
Asian or Native Hawaiian or Pacific Islander or South Asian
Black or African American
Caucasian or White
Hispanic or Latino/Latina
Indigenous American or Alaska Native
Middle Eastern or North African
Other (please specify)
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8.
Do you, or does anyone in your household currently or have ever worked in any of the following types of industries or professions?
(Required.)
Market research, marketing or advertising
A manufacturer, distributor, or retailer of frozen food products
A company that processes or distributes water products of any kind, including ice
The news media, such as television, radio or newspaper
A company that makes, repairs or sells household appliances/electronic services
A public relations firm or executive search firm
As a social media influencer
None of these
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9.
When was the last time, if ever, you, yourself, participated in a marketing research study for any marketing research company?
(Required.)
Never
More than 3 months ago
Within the past 3 months
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10.
What was the topic of the research study you participated in? If none put N/A
(Required.)
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11.
Are you currently participating or scheduled to participate in any market research projects with us or any other market research company?
(Required.)
Yes
No
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12.
Which statement best describes your household’s interest in ice for cooling your drinks, eating, etc?
(Required.)
Love ice
Could take it or leave it
Not a fan of ice
