Focus Group Sign Up Page Step 1 of 10 10% NAME*Please enter your first and last name. First Middle Last Email*Please enter a valid e-mail address. Enter Email Confirm Email Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Please enter your Phone Number DO YOU HAVE ANY CHILDREN?*Are you a parent/step parent to any children, please Yes or No belowYesNoRelationship Status*Please select the option that best describes your current relationship status.SingleMarriedDivorcedWidowedSeparatedEngagedIn a Relationship RACEAre you of Hispanic, Latino or Spanish Origin?*Please select below.No, not of Hispanic, Latino or Spanish OriginYes, Mexican, Mexican AM, ChicanoYes, Puerto RicanYes, CubanYes, another Hispanic, Latino or Spanish OriginWhat is Your Race?*If you answered 'NO' above, please select an option below.WhiteBlack, African AmericanAmerican Indian or Alaska NativeAsian IndianChineseFilipinoJapaneseKoreanVietnameseOther AsianNative HawaiianGuamanian or ChamorroSamoanOther Pacific Islander GENDER*Please select your gender from the below optionsMaleFemaleAGE*What is your age? HAVE YOU EVER SERVED ON A JURY?*Please select Yes or NoYESNOHave you ever been convicted of a felony?*Please select Yes or NoYesNoPrefer Not to Answer Employment Status*Please select an option that best describes your current Employment Status.Employed Full-TimeEmployed Part-TimeSelf-employedInternContractNot employed but looking for workNot employed and not looking for workHomemakerRetiredStudentSeasonalPrefer Not to AnswerIndustry*Please select the most relevant Industry that you participate or work/have worked in.Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOther EDUCATION*Please select an option that best describes your current education level.High SchoolAssociate DegreeTechnical DegreeBachelor's DegreeGraduate or Professional DegreeSome CollegePrefer Not to AnswerINCOME RANGE*Please select your total annual household income.Less than $40,000$41,000 - $75,000$76,000 - $100,000$101,000 - $199,000$200,000 and above Religion*Please select an option that best describes your religious views.ChristianMuslimBuddhistJewishHinduNon - ReligiousAgnosticPolitical Affiliation*Please select an option that best describes your political affiliationRepublicanDemocratIndependentNone WHAT MAGAZINES/NEWSPAPERS DO YOU LIKE TO READ?*Please type belowHOW DID YOU HEAR ABOUT US?*CRAIGSLISTFACEBOOKPRINT ADLOCAL MESSAGE BOARDWORD OF MOUTH/REFERRAL
