Research Database Registration


You agree that you are providing the following information voluntarily for the purpose of being included in our research study database. The research studies conducted include but are not limited to Online Surveys, Focus Groups, and Individual Depth Interviews (IDI's). Some of the studies may include a monetary honorarium. However, cannot guarantee that you will be selected for a research study. See our Privacy Policy for more information on how your information may be used.

Your e-Mail Address

Your First Name

Your Last Name


In what month were you born?

In what year were you born? (Four-digit year such as "1965")

What city do you live in?

What state do you live in?

What is your Zip Code?

Which of the following best describes the ethnic group in which you belong—
     African American
     American Indian or Alaska Native
     White or Caucasian
     Native Hawaiian or Other Pacific Islander
     Prefer Not to Say
     Don't know

Are you currently—
     Employed Full Time
     Employed Part Time
     Not Employed


What is your approximate annual household income before taxes?
     Please Choose One
     Less than $25,000
     $25,000 to $49,999
     $50,000 to $74,999
     $75,000 to $99,999
     $100,000 to $149,999
     $150,000 or higher
     Prefer Not To Say
     Don't Know

What kind of Internet access do you have?
     Dial Up
     Don't Know

Have you read and do you agree to our Statement of Agreement

Thank you for joining the database!