Houston Studies - Beer Studies March & April 2017

1. Intro Section

Plaza Research Houston is conducting a study for Male & Females ages 21-34 years old who consume Craft Beer. The discussions will be held on

Tuesday, April 25, 2017
- Location: Plaza Research Houston
- Pays: $125/1.75 hr
- Time: At various times in day & evening.

If you're interested please fill out the questions below. 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:

Email Address:

Phone Number:

Question Title

* 2. Alternate Contact number

Question Title

* 3. What is your date of birth?

Date

Question Title

* 4. What is your age?

Question Title

* 5. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

American Indian or Alaskan Native

Asian

Black or African-American

From multiple races

Hispanic

Native Hawaiian or other Pacific Islander

White

Some other race (please specify)

Question Title

* 6. The project on March 29th requires you participate with a friend. If you would like to participate, please put the Name, Phone Number and Email of each friend that will be willing and able to participate with you.