*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.

2.Thanks again for your interest in the food study! The group will take place online via webcam on Tuesday, March 17th or Wednesday, March 18th. If you qualify and participate, you will receive $125 for the first hour of participation and if selected for the second hour of the study you will receive an additional $100.
You MUST be available for the entire 2 hours to be considered for the study.
Please check off which times, if any, you'd be available. If you qualify and we have a spot for you we will be in touch!

Please keep in mind checking off times does NOT mean you are recruited for the project; you MUST be contacted by a recruiter.

Thursday, March 26th 3pm pacific time / 5pm central time / 6pm eastern time (2 hour session)

Friday, March 27th 11am pacific time / 1pm central time / 2pm eastern time (2 hour session)

I am not available

*3.CONTACT INFO Please provide the following:(Required.)

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

*4.Where in the country do you live?(Required.)

Southern CA

Northern CA

West outside of CA

Illinois

Midwest outside of Illinois

South

East

Northeast

5.Which of the following best describes you?

Male

Female

Other (please specify)

6.What age category do you fall under?

Under 18

18-24

25-34

35-45

46-55

56-64

65+

7.What is your exact age and date of birth?

Age

Date of birth

8.Are you of Spanish, Hispanic, or [Latino/Latina] origin?

Yes

No