Houston Study Health and Beauty April 2020

Introduction Section

Plaza Research Houston is conducting a 14 day trial study with Women ages 25-45 on Health and Beauty. The discussion takes place in the beginning of April. If you qualify, and are chosen to participate, you will receive $175 for 1 hour of your time daily.
**Proof will be required in order to participate if chosen**

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

State/Province *

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?