Participate in Research We are recruiting participants for a number of surveys for which you will be paid. If you are interested in being considered, please fill out all the questions below. If selected, you will be contacted by email or phone to participate in a personal interview or a focus group in your area. First Name: Last Name: E-Mail: Address1: Address2: City: U.S. State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Other: Zip: Country: Home Area Code: Telephone: Business Area Code: Telephone: Internet Use Aside from email, how often do you use the Internet? throughout the day several times a day every day several times a week once a week several times a month less than once a month How many other web users are there in your household? Just me 1 other 2 others 3 or more others About your household How old are you? under 18 18 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 or more How many adults (18 years or older) are in your household? 1 2 3 4 or more What are the ages of children (under 18) in the household? Check all that apply. 0 - 5 years old 6-12 years old 13 - 17 years old Are you single, never married married or living with partner formerly married, widowed, divorced What best describes your ethnic background? Caucasian African American Hispanic Asian Other Approximately, what is the total yearly income for your household? under $15,000 $15K to $24K $25K to $34k $35K to $54K $55K to $64K $65K to $74K $75K to $99K $100K to $199K $200K to $299K $300K or more What is your occupation? If you are interested in taking part in other marketing or social research projects for which there is compensation, we recommend Cobbey&Associates. Thank you! We will contact you when we have a need. This questionnaire was created by The NevadaWeb.
throughout the day several times a day every day several times a week once a week several times a month less than once a month
How many other web users are there in your household?
Just me 1 other 2 others 3 or more others
under 18 18 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 or more
How many adults (18 years or older) are in your household?
1 2 3 4 or more
What are the ages of children (under 18) in the household? Check all that apply.
0 - 5 years old 6-12 years old 13 - 17 years old
Are you
single, never married married or living with partner formerly married, widowed, divorced
What best describes your ethnic background?
Caucasian African American Hispanic Asian Other
Approximately, what is the total yearly income for your household?
under $15,000 $15K to $24K $25K to $34k $35K to $54K $55K to $64K $65K to $74K $75K to $99K $100K to $199K $200K to $299K $300K or more
What is your occupation?