Online Survey & Focus Group Sign-Up
We need to know something about you so that we will know which online focus groups and surveys you might qualify for. This information will be used only for research and never to try to sell you anything.
1. Please begin by providing your e-mail address. This will be used to notify you of upcoming surveys and online focus groups, so please make sure that the information is complete and correct.
your e-mail address?

 2. Please tell us about your current work status.
Work part-time
Work full-time
Temporarily unemployed
College student
Graduate student
Retired
Self-employed
Disabled
Homemaker

 3. Please select the category that best describes the industry in which you work.
Industry:

 4. Please choose the category below that best describes your title.
CEO/President/Owner/General Manager
Vice President/Assistant Vice President
Treasurer/Controller/Chief Financial Officer
Director/Assistant Director/Section Head
Manager/Assistant Manager
Supervisor/Assistant Supervisor
Administrative Support/Clerical
Consultant
Other, please specify

5. Education Level:
Some high school or less
Graduated High school
Some college
Graduated two-year or technical college
Graduated four-year college
Some graduate school
Completed Graduate school or higher

 6. How do you connect to the Internet?
dial-up modem
hi-speed broadband (e.g. DSL, cable modem, T1, ISDN, etc.)

 7. Gender?
Female
Male

 8. How old are you?
Under 15 years
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
65 or older

 9. Marital Status?
Single (never married)
Domestic partnership
Married
Married with children
Divorced/separated
Widowed

 10. Are you currently a homeowner?
Yes
No

 11. Number of children under 21 years of age living in your home?
none
one
two
three
four
more than four

 12. What is your ethnicity?
African American
Asian
Caucasian
Hispanic
Native American
Other

 13. Which of the following best describes your total household income before taxes last year?
Under $10,000
$10,000 - $19,999
$20,000 - $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
$70,000 - $79,999
$80,000 - $89,999
$90,000 +
14. Mailing address (we need to know where to send the check)
First Name
Last Name
Street Address
City
State
Zip/Postal Code
Country