Houston Study - Beverages Feb 2017

1. Intro Section

Plaza Research Houston is conducting a focus group for Males and Females ages 15-24 years old on the topic of Beverages. This focus group will be held on Wednesday, February 28, 2017 at various times throughout the afternoon and evening. If you qualify and participate, you will receive $100 for 1.75 hours of your time.

Those under the age of 18 will need parents approval to participate.

If you're interested please fill out the questions below.

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:

Email Address:

Phone Number:

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* 2. Alternate Contact number

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* 3. What is your date of birth?

Date

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* 4. What is your age?

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* 5. Are you male or female?

Male

Female