Houston Study - Snacks April 2017

1. Introduction Section

Plaza Research Houston is conducting a discussion with Moms and their kid on the topic of Snacks . The discussion will take place on Wednesday, April 4th or Thursday, April 5th, 2017, time varies throughout the day. If you qualify and participate with your child, you will $175 for 2-hours of your time.

Please answer the questions below. If you look like a match, we will contact you by telephone.

**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.

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* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

Name:

ZIP/Postal Code:

Email Address:

Phone Number:

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* 2. Alternate Contact number

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* 3. What is your age? Whole number, no ranges or words

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* 4. What is your Gender?

Female

Male

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* 5. Do you have children under the age of 18 living at home?

Yes

If yes, please list the age and gender of each