Interested in getting involved in PAID Market Research Studies???

Register to be part of Act One Research Services' Database!

Please fill out the survey below

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Once we have received the necessary information, we can get you a profile in our respondent recruiting database. As a member of our database you may receive phone calls or emails about upcoming paid market research studies. By fully completing the survey below, we can find the best ways to put you to use!

Please Note: All information that you provide to us is totally voluntary and is kept private. The information in our database is only used for the purposes of matching respondents to our potential market research studies. You will not receive any solicitations to purchase any product as a result of your membership in our database.

We are currently working on expanding our database to include more members. If you know anyone else who you think might be interested in participating in these kinds of studies, feel free to pass along the link to this survey.

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* 1. Please provide the following contact and location information:

Name: *

City/Town:

Zip Code:

State:

Primary Phone Number:

Daytime Phone Number (if different from above):

Email Address:

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* 2. What is your date of birth?

Date:

Date

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* 3. Gender

Male

Female

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* 4. Which category best describes your ethnic background?

Other (please specify)

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* 5. Which category best describes your living status?

Other (please specify)

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* 6. What is your sexual orientation?

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* 7. What is your highest completed level of education?

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* 8. Please provide an estimate of your Annual Household Income

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* 9. Do you have any children under 18?

Yes

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* 10. Please list the genders and ages of your children living at home.

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* 11. Do you own or rent at your current residence?

Rent

Own

Other

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* 12. What is your occupation and in what industry? If you are a student, what is your field of study?

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* 13. On average, how often do you travel for business?

Weekly

Monthly

A few times a year

Less than a few times per year

Never

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* 14. How often do you take leisure vacations that require one or multiple overnight stays?

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* 15. When traveling, what hotel(s) do you frequent?

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* 16. Please list any Hotel/Airline Travel Programs you are enrolled in (Ex: SW Rapid Rewards, United Airlines MileagePlus, etc.):

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* 17. Thinking about your technology & gadgets, please let us know if you own the following:

	Own	Plan to Purchase	Plan to Upgrade / Replace
Smart Phone	Smart Phone Own	Smart Phone Plan to Purchase	Smart Phone Plan to Upgrade / Replace
Please provide Make & Model
Tablet	Tablet Own	Tablet Plan to Purchase	Tablet Plan to Upgrade / Replace
Please provide Make & Model
Laptop Computer	Laptop Computer Own	Laptop Computer Plan to Purchase	Laptop Computer Plan to Upgrade / Replace
Please provide Make & Model
Desktop Computer	Desktop Computer Own	Desktop Computer Plan to Purchase	Desktop Computer Plan to Upgrade / Replace
Please provide Make & Model

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* 18. Who are your service providers for:

Cable

Internet

Cell Phone

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* 19. We often do healthcare studies, do you have any of the following:

	Yes	No
Medical Conditions	Medical Conditions Yes	Medical Conditions No
Food Allergies	Food Allergies Yes	Food Allergies No
Dietary Restrictions	Dietary Restrictions Yes	Dietary Restrictions No
Mobility Concerns	Mobility Concerns Yes	Mobility Concerns No

If you answered "yes" to any of the choices above, please explain below:

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* 20. Do you have any pets?

Cat(s)

Dog(s)

Fish (Tropical or Fresh Water)

Bird(s)

Rabbit

Hamster/Guinea Pig/Ferret

Turtle/Snake/Reptile

Other (please specify)

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* 21. Do you own or lease a vehicle?

Make:

Model:

Year:

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* 22. Do you drink alcohol?

Yes

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* 23. In regards to alcohol, what do you drink? Please check all that apply.

Beer

Wine

Mixed Drinks / Cocktails

Hard Liquor (no mixers)

Liqueurs / Cordials

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* 24. In regards to spirits/hard liquor, what do you drink? Please check all that apply.

Vodka

Flavored Vodka

Rum (Light)

Rum (Dark or Spiced)

Gin

Tequila

Whiskey

Brandy

Cognac

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* 25. What are your top 3 favorite beers?

Favorite!

2nd

3rd

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* 26. What are your go to brands when purchasing alcohol?

First Choice

2nd

3rd

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* 1. Please provide the following contact and location information:

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* 2. What is your date of birth?

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* 3. Gender

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* 4. Which category best describes your ethnic background?

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* 5. Which category best describes your living status?

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* 6. What is your sexual orientation?

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* 7. What is your highest completed level of education?

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* 8. Please provide an estimate of your Annual Household Income

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* 9. Do you have any children under 18?

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* 10. Please list the genders and ages of your children living at home.

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* 11. Do you own or rent at your current residence?

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* 12. What is your occupation and in what industry? If you are a student, what is your field of study?

Question Title

* 13. On average, how often do you travel for business?

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* 14. How often do you take leisure vacations that require one or multiple overnight stays?

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* 15. When traveling, what hotel(s) do you frequent?

Question Title

* 16. Please list any Hotel/Airline Travel Programs you are enrolled in (Ex: SW Rapid Rewards, United Airlines MileagePlus, etc.):

Question Title

* 17. Thinking about your technology & gadgets, please let us know if you own the following:

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* 18. Who are your service providers for:

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* 19. We often do healthcare studies, do you have any of the following:

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* 20. Do you have any pets?

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* 21. Do you own or lease a vehicle?

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* 22. Do you drink alcohol?

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* 23. In regards to alcohol, what do you drink? Please check all that apply.

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* 24. In regards to spirits/hard liquor, what do you drink? Please check all that apply.

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* 25. What are your top 3 favorite beers?

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* 26. What are your go to brands when purchasing alcohol?

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* 27. What do you like to do in your spare time? (Creative Pursuits, Physical Activities, or Hobbies)