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First Name

Last Name

What is your Date of Birth?

What is your Gender?

Home Phone (xxx) xxx-xxxx

Work Phone (xxx) xxx-xxxx

Do you own a cell phone?

Cell Phone (xxx) xxx-xxxx

What is your home street address?

City

State

County/Parish (not country)

Zip Code

Do you have an Email Address

What is your current marital status?

Do you own or rent your current home?

What is your current employment status?

Which of the following BEST describes your occupation?

What is your current ter status?

Do you have a computer in your home?

Do you have internet access at home?

What is the highest level of education you have completed?

What do you consider to be your ethnic background?

Which of these ranges includes your total annual household income before taxes?

Do you have any children in your household under 18 years of age?

We conduct many projects that want to hear the opinions of adults with children of specific ages in their household. If you answered 'Yes' to the above question please tell us the gender and date of birth of each child in your household, starting with the youngest and ending with the oldest.

Child 1: GenderBirthdate

Child 2: GenderBirthdate

Child 3: GenderBirthdate

Child 4: GenderBirthdate

Child 5: GenderBirthdate

Child 6: GenderBirthdate

Do you use any tobacco products?
If YES, What brand do you use most often?

Do you pay for a satellite radio subscription in any of your automobiles?

How did you hear about the Consumer Logic website?

Click SUBMIT only once. Submitting more than one Profile will NOT increase your chances of being selected for a study.