First Name

Question Title

* 1. First Name

Last Name

Question Title

* 2. Last Name

Email Address

Question Title

* 3. Email Address

Phone Number

Question Title

* 4. Phone Number

What is your zip code?

Question Title

* 6. What is your zip code?

What is your gender?

Question Title

* 7. What is your gender?

What is the highest level of school you have completed or the highest degree you have received?

Question Title

* 9. What is the highest level of school you have completed or the highest degree you have received?

Which of the following categories best describes your employment status?

Question Title

* 10. Which of the following categories best describes your employment status?

Do you work in any of the following industries?

Question Title

* 11. Do you work in any of the following industries?

What is your job title?

Question Title

* 12. What is your job title?

How much total combined money did all members of your HOUSEHOLD earn last year?

Question Title

* 13. How much total combined money did all members of your HOUSEHOLD earn last year?

Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group?

Question Title

* 14. Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group?

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

Question Title

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

Which of the following best describes your current relationship status?

Question Title

* 16. Which of the following best describes your current relationship status?

How many children are you parent or guardian for and live in your household (aged 17 or younger only)?

Question Title

* 17. How many children are you parent or guardian for and live in your household (aged 17 or younger only)?

Which of the following items do you own?

Question Title

* 19. Which of the following items do you own?

Tell us a little bit about you:
Do you own any pets?

Question Title

* 20. Do you own any pets?

Do you rent or own the place you live in?

Question Title

* 21. Do you rent or own the place you live in?

Do you consume any of the following?

Question Title

* 22. Do you consume any of the following?

Do you smoke cigarettes?

Question Title

* 23. Do you smoke cigarettes?

How did you hear about us?

Question Title

* 25. How did you hear about us?

Would you like to be contacted for future (paid) market research opportunites?

Question Title

* 26. Would you like to be contacted for future (paid) market research opportunites?

T