Participant Information Form

Elliott Benson Research is an organization interested solely in collecting opinions. As a participant in one of our studies, you could help to create new products, services, advertising, or possibly impact decisions in the local government, and the best part is that you'll be paid for your opinions!

Please keep in mind that some of our clients seek participants who meet very specific needs, so the more we know about you, the more likely we are to contact you for our studies!

We keep all information strictly confidential and we never sell our database to outside sources.
1.Contact Information(Required.)
2.What is your gender?(Required.)
3.What is your age?(Required.)
4.What is your birthdate?  Please use the format MM/DD/YYYY
5.Which of the following best indicates your ethnicity?(Required.)
6.What is your current marital status?(Required.)
7.Which of the following best represents your current employment status?(Required.)