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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.

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3.What is your gender?

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Other (specify)

4.Please select your current age range.

Under 18

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25-29

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5.For classification purposes only, please tell me which of the following best describes your ethnic background?

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6.Sometimes we need to speak with people who have and who haven’t been to market research studies in the past. When, if ever, was the last time you participated in a market research study?

0-3 months ago

More than 3 months ago