CONSUMERPANEL

Thank you for your interest in participating in our research panel. Please take a few minutes to answer the following questions and we'll add you to our database.

FIRST, PLEASE VERIFY YOU'RE HUMAN!

Contact Information

* First Name :
* Last Name :
Mobile or Best Phone :
* Email Address :

* Gender:

Male

Female

Other

* In what year were you born?

Year

* Where do you live?

* State:

Please enter your 5-digit US zip code.

Please press Next.

* Province:

Please enter your Canadian zip code? (e.g., M5G 1C3: 3 characters space 3 characters)

Please press Next.

Please enter your France Postal Code.

Please press Next.

Please enter your UK Postal Code. (UK)

* In what city or town do you live?

* Are you...

Living single

Living with spouse/partner

* Do any of the following types of people live in your household?
(Select all that apply)

* What type of Chronic Disease or Mental Illness do you or others living in your household have?

* Level of Education

* Please select which of these best describes your type of employment?

* Please select which of these best describes your partner or spouse's type of employment?

* Which of these best describes the industry in which you work?

* And which best describes the industry in which your spouse or partner works?

If you have a LinkedIn Profile, please enter it below to be considered for executive or business studies or press next to skip. You may cut and paste. Note all LI addresses start with https://www.linkedin.com/in/

Please press Next.

* And finally, what is your approximate annual household income?