*1.FOR IN PERSON RESEARCH:
In order to gain admittance to the facility, you need to bring:

• A Photo ID
• Reading glasses if you need them

Please make sure to self assess your health prior to the session and we ask that you cancel in advance if you are sick with Cold/Flu/Covid-19 symptoms. 

Frequently we do not allow cell phones, smart watches, cameras or any electronic/digital devices into the research. There is a possiblity you will be asked to leave your devices with our front desk team where they will be kept securely during the research. 

If qualified and based on these participation requirements, are you willing to participate in this in-person interview?(Required.)

Yes

No

*2.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.

*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.What is your gender?(Required.)

Male 

Female

Non Binary 

Prefer not  to say 

*5.Do you currently get paid in any way to test or play mobile or console video games? Either through apps, YouTube. Twitch or other?  (Required.)

Yes

No

*6.Are you or is any of your close family or friends employed by or retired from any of the following types of companies? (Required.)

An advertising agency or public relations firm

A market research firm or marketing department within a firm

Graphic art or graphic design company

A manager or executive at a company that manufactures or sells toys

video, computer games or music

Software development company or website development

Entertainment industry studio/production

None of The Above