Join Our Panel Application 1 Contact Information2 Employment & Education3 Demographics4 Hobbies & Interests Are you interested in sharing your opinions to help businesses build better products, market to "you" or simply understand your opinion on important social issues? If so, please consider inclusion in our Respondent Database, our "Panel". As an active respondent you will be contacted for opportunities to answer online surveys, telephone or in-person interviews or participate in focus groups. All of which provide an opportunity for you to be compensated for your time and opinions. If you are interested, please fill out the following confidential form and we will add you to our database. Please note, you will never be asked to purchase anything. All of your data and feedback is confidential, and you may opt out at any time. We will use your contact information only to inform you of opportunities. This information is protected by the CASRO Standards of Privacy which can be reviewed at https://www.casro.org/?Page=PrivacyPolicy and you will not be contacted for any sales-related calls as a result of your participation.Name* First Last Home PhoneCell Phone*Email* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Social Media UsagePlease select all of the social media sites that you visit. If you have accounts on any of the sites, please list them below. Facebook LinkedIn Twitter Pinterest YouTube Craigslist None of the Above FacebookIf you selected Facebook in the previous question, please provide your Facebook ID.LinkedInIf you selected LinkedIn in the previous question, please provide your LinkedIn ID. How did you hear of us?Birthdate GenderMaleFemaleOtherPlease describe your current employment status.Employed for wages - Full-timeEmployed for wages - Part-timeSelf-employedOut of work and looking for workOut of work but not currently looking for workHomemakerStudentRetiredDisabledPlease describe your type of work.Employee of a for-profit company, business or individual for wages, salary or commissions..Employee of a not-for-profit, tax-exempt or charitable organization.Local government employee (city, county, etc.)State government employee.Federal government employee.Self-employed in own, not-incorporated business, professional practice or farm.Self-employed in own incorporated business, professional practice or farm.Working without pay in family business or farm.What is the highest degree or level of school you have completed? If currently enrolled, mark the previous highest degree received.High School or GEDAssociates DegreeSome CollegeBachelor's DegreePost GraduatePhD Race / EthnicityPlease identify your race or ethnicity. Caucasian / WhiteAfrican AmericanHispanic / LatinoAsianMiddle EasternOtherPrefer Not to IndetifyReligionChristianCatholicJewishMuslimGreek OrthodoxAtheistAgnosticOtherPrefer Not to IdentifyPolitical AffiliationPlease identify your political affiliation. DemocratRepublicanIndependentDo Not VotePrefer Not to IdentifyFavorite Music GenrePlease identify your favorite music genres. ClassicalCountryJazzPopAlternativeRapDo you smoke?YesNoHow many children do you have?None1234 or moreDo you have any pets?YesNoIf you selected yes, please identify the type and number of pets in your household.What is your marital status?SingleMarriedDivorcedSeparatedOtherWhat is your marital status?SingleMarriedDivorcedSeparatedOtherWhat is your total annual household income?Less than $10,000$10,000 to $29,999$30,000 to $49,999$50,000 to $69,999$70,000 to $89,999$90,000 to $109,999$110,000 to $139,999$150,000 +Prefer Not to AnswerWhat is your living arrangement?OwnRentLive with Family or FriendLive with Family or Friend What activities and interests do you enjoy? Antiques Astrology Birdwatching Cake Decorating Camping Computer Games Cooking Dancing Diving / Snorkeling Fishing Gardening Genealogy Hiking Horseback Riding Hunting Ice Skating Jewlery Making Writing Knitting Marathons Martial Arts Movies Photography Reading Running Running Tennis Traveling This iframe contains the logic required to handle AJAX powered Gravity Forms.