*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 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.

*2.CONTACT INFO Please provide the following:(Required.)

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

*3.What age range do you fall into:(Required.)

20 & under

21-30

31-39

40-50

51-60

61 +

*4.What is your exact age and date of birth:(Required.)

Age:

DOB:

*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:(Required.)

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

*6.What is your employment status:(Required.)

Full-time

Part-time

Homemaker

Student

Not employed

*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.*(Required.)

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:

*8.When was the last time you participated in a market research discussion or a one-on-one interview about products or services?(Required.)

Within the past 6 months

6-12 months

Over 1 year

Never

*9.What was/were the subject(s) of the discussion(s) in which you have participated?(Required.)

*10.Which of the following best describes you?(Required.)

Male

Female

Non-Binary

Prefer not to say

Prefer to self-describe

*11.For statistical purposes, please tell me with which of the following racial backgrounds do you most identify? Check all that apply(Required.)

Black/African-American

Asian

Caucasian

Hispanic/Latino

Other (please specify)

*12.Please tell me which of the following, if any, have you personally purchased AND consumed in the past 30 days?(Required.)

Alcoholic Beverages

Tea

Coffee

Juice

Bottled water

None of the above