*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.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

*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.Do you live in California?

Yes

No

Don't Know/Prefer Not to Answer

5.Are you registered to vote in California?

Yes

No

Don't Know/Prefer Not to Answer

6.Please tell me if YOU are CURRENTLY employed in any of these types of companies, occupations, or industries, if you have EVER worked in any of these industries, or if anyone else in your household now works in any of them...

A newspaper, magazine, radio or television station, or an online news outlet

An advertising or public relations agency

A market or public opinion research company

A federal, state, or local government agency

A political party, elected official or candidate for political office

At a law firm or for the judicial or court system or in the legal profession

At a health care organization, such as a doctor’s office, hospital, or clinic that treats patients

None of the Above

7.Are you or is someone in your household a current or retired labor union member?

Yes – self

Yes – someone else in household

No

Don’t know

Prefer Not to Answer