Question Title * 1. 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 InfoFinancial Incentive InfoAdler Weiner Privacy Policy 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. Question Title * 2. CONTACT INFO Please provide the following: Name * Address * Apt # if applicable City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * Question Title * 3. What age range do you fall into: 20 & under 21-30 31-39 40-50 51-60 61 + Question Title * 4. What is your exact age and date of birth: Age: DOB: Question Title * 5. Research companies are particularly interested in knowing if people have some relationship with or knowledge about certain occupations. Think about the job(s) and occupations you and members of your family, close friends and relatives hold. Do any have jobs that are in the following types of companies or have related job titles: Manufacturing, distribution or retail sales of alcoholic beverages ( ) A restaurant bartender, cocktail waitress or a server at any establishment that serves alcoholic beverages A deli, supermarket or price club that sells alcoholic beverages Marketing or market research Advertising agency or public relations Television, radio, magazine, or newspaper Direct mail or promotional agency None of the above Question Title * 6. What is your employment status: Full-time Part-time Homemaker Student Not employed Question Title * 7. Please tell me all the occupations, industries and type of businesses you and other adults in the household hold and work in currently. *Only fill out whatever applies to your household. i.e. If single, only fill out your occupation info.* Your current occupation: Your company name: Your industry: Spouse's/Partner's current occupation: Spouse's/Partner's company name: Spouse's/Partner's industry: Other adult current occupation: Other adult company name: Other adult industry: Question Title * 8. When was the last time you participated in a market research discussion or a one-on-one interview about products or services? Within the past 6 months 6-12 months Over 1 year Never Question Title * 9. What was/were the subject(s) of the discussion(s) in which you have participated? Question Title * 10. Which of the following best describes you? Male Female Non-Binary Prefer not to say Prefer to self-describe Question Title * 11. For statistical purposes, please tell me with which of the following racial backgrounds do you most identify? Check all that apply Black/African-American Asian Caucasian Hispanic/Latino Other (please specify) Question Title * 12. Please tell me which of the following, if any, have you personally purchased AND consumed in the past 30 days? Alcoholic Beverages Tea Coffee Juice Bottled water None of the above Next
