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

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

3.What gender do you identify as?

Male

Female

Non-Binary

Other (please specify)

4.What age range do you fall into?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

5.What is your exact age?

6.Which of the followingbest describes you?

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

Hispanic

White

Other (please specify)

7.Which of the following best describes your household’s total annual income, after taxes?

Less than $25,000

$25,000 to less than $50,000

$50,000 to less than $75,000

$75,000 to less than $100,000

$100,000 to less than $125,000

$125,000 to less than $150,000

$150,000 to less than $250,000

$250,000 to less than $500,000

$500,000 to less than $1,000,000

$1,000,000 or more

8.We are interested in talking to people with a variety of backgrounds. Have you, or have any members of your family, worked (either currently or at some point) in any of the following types of companies?

Marketing Research

Advertising, Marketing or Public Relations Firm

Media (i.e. TV, radio, entertainment industry, streaming service, gaming, newspaper)

Social Media, Online or Internet Services – including digital marketing, social networking

Healthcare

Technology

Retail

Manufacturing

Telecommunications or Telephone Company

Automotive

None of the above