Houston Study - Bellaire Residents September 2017

1. Introduction Section

Plaza Research Houston is conducting a discussion with consumers ages 18-65 years old living in the City of Bellaire. The discussion takes place on Tuesday, September 26th, 2017 during the day. If you qualify, and are chosen to participate, you will receive $75 for 1.75 hours of your time and lunch will be provided.

All must show proof of residency.

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.

Question Title

* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

Name:

ZIP/Postal Code:

Email Address:

Phone Number:

Question Title

* 2. Alternate Contact number

Question Title

* 3. What is your age?

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* 4. What is your gender?

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* 5. In which area of Houston do you currently live/reside?

West University

Memorial

River Oaks

Bellaire

The Heights

Other (please specify)