Houston Study -Beer August 2018

Introduction Section

Plaza Research Houston is conducting a discussion with consumers from ages 21-49 on the topic of Beer. The discussion takes place Wednesday, August 15th, 2018, time varies throughout the day and evening. If you qualify, and are chosen to participate, you will receive $100 for 90 minutes of your time PLUS a $50 Early Bird Lottery for one lucky winner who arrives at the study early.

**Proof may be required in order to participate if chosen**

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.

Question Title

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

First Name *

Last Name *

City/Town

ZIP/Postal Code: *

Email Address: *

Phone Number: *

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* 2. Alternate Contact number

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* 3. What is your age?

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* 4. What is your date of birth?

Date

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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.

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* 2. Alternate Contact number

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* 3. What is your age?

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* 4. What is your date of birth?

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* 5. What is your gender?