Rothermel Research, a Chicago-based marketing research company, is frequently asked by product manufacturers to talk to consumers about the products they use or about test products currently being developed. If you would like to assist in these PAID consumer research studies, please complete the following information. Be assured that all of your information is kept strictly confidential and solely used for research purposes. Thanks for joining!

Question Title

* 1. Please fill out your basic contact details below

Question Title

* 2. Are you available for daytime studies, evening studies or both?

Question Title

* 3. Gender

Question Title

* 4. Marital status

Question Title

* 5. Ethnicity. If Bi-racial, select all that apply

Question Title

* 6. Current employment status

T