Houston Study - Phone Communication June 2018

Introduction Section

Plaza Research Houston is conducting a discussion with consumers from ages 18 and older on the topic of Phone Communications. The discussion takes place the week of July 23, 2018, time varies throughout the day and evening. If you qualify, and are chosen to participate, you will receive $150 upon completion of Phase 1, and if selected for Phase 2, you will receive an additional $125.
**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.

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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: *

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 gender?

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* 5. In which languages are you fluent? (check all that apply)

English

Spanish

Chinese

French

Other (please specify)