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The Premier Online Survey Site

Please complete all fields accurately and completely.
All fields with asterisks are required and invalid information may disqualify your submission.
First Name: *
Last Name: *
E-mail: *
Street Address:
Zip/Postal Code:
Mobile Phone:
Mobile Carrier:
Other Carrier:
Demographic Information:  
Date of Birth:
Are you a parent of a child under 18 currently living in your household?
Number of Children:
What is the age of your child?
What grade is your child in?
Do you have a child planning to attend college?
Are you expecting a new child?
If yes, when?
What type of parenting information interests you the most?
Select all that apply.
Baby Apparel
Baby Bath & Potty
Baby Foods
Baby Registry
Baby Toys
Baby Health & Safety
Car Seats & Strollers
Maternity Books
Maternity Clothes
Nursery Furniture
Marital Status:
Marital Status:
Are you engaged?
Do you plan on getting married in the next year?
Household Information:
Do you own or rent your residence?
Dwelling Type:
Household Income:
Questions for Renters:
Are you interested in purchasing a home?
Are you interested in building a new home?
Are you interested in purchasing an existing home?
If so, in what timeframe?
Would you be interested in receiving mortgage offers?
Will you be using a moving company?
Are you using a real estate agent to assist you with your search?
Educational Information:
Highest Level of Education:
Are you currently attending college?
What type of college or university are you currently attending?
What year are you currently in?
If you are not currently enrolled, do you plan on attending a college or a university?
Employment/Career Information:
Employment Status:
Industry Employed In:
Job Title:
Are you interested in a career change?
Are you in the Armed Forces?
Are you considering leaving the Armed Forces?
Are you a US Veteran?
Behavior/Lifestyle Demographics:
What political party are you?
Are you an active political donor?
What is your ethnicity?
What nationality are you?
Would you like to receive offers relating to your ethnic background?
What is your preferred language?
What is your religion?
What type of vehicle do you drive?
Please indicate Make, Model and Year
Are you planning to purchase a new vehicle soon?
Is your home currently equipped with an alarm system?
Do you own a boat?
Do you own a motorcycle?
Do you own a pet?
Please select which pets you own (Choose all that apply): Dog

What brand of pet food do you purchase?
Investing/Insurance Demographics:
Are you interested in investing in financial products?
Are you interested in investing in real estate?
Are you interested in purchasing insurance?
If yes, what kind of insurance?
Buying/Shopping Demographics:
Are you a wine enthusiast?
What type of wine do you enjoy?
Do you consider yourself a cheese enthusiast?
Do you enjoy coffee?
How many cups of coffee do you drink per day?
What is your preference for purchasing coffee?
Do you smoke?
If yes, do you smoke cigarettes or cigars?
Are you planning to quit smoking?
Do you use smokeless tobacco products?
Are you planning to quit using smokeless tobacco products?
Do you use a major credit card to make online purchases?
Do you shop online?
Do you shop from catalogs?
Do you like to shop with coupons?
Do you like to shop in high end retail stores?
Do you like to shop in discount warehouses?
Do you enjoy fast food?
How many times a week do you eat fast food?
Who does the grocery shopping in your household?
How often do you go grocery shopping?
Do you use coupons when you go grocery shopping?
Do you purchase food in bulk?
Do you purchase organic food?
When was the last time you purchased cosmetics or fragrances?
Are you - or your parents - looking at senior/retirement communities as an alternate to staying in your own home?
What brand of gasoline do you prefer?
What type of fuel do you use in your vehicle?
How often do you fill your gas tank?
Would you like to receive offers for gasoline promotions?
Are you interested in buying furniture for your residence?
Are you interested in remodeling your home?
Do you own a platinum or premium credit card?
Are you a premier airlines rewards member?
Are you a premier hotel rewards member?
Do you belong to any premium dining clubs?
Do you fly first class?
How often do you purchase jewelry?
Where do you purchase your jewelry?
Do you purchase jewelry for yourself or for gifts?
Do you purchase designer jewelry?
Entertainment Demographics:
Are you a sports fan or participant?
Which sport?
Are you a fantasy sports player? If so, which sport?
Do you own an iPod or MP3 Player?
Do you have broadband Internet Access?
Do you use Social Media websites?
Do you have Satellite TV?
Do you subscribe to Satellite Radio?
Do you enjoy watching movies at home or at theaters?
What type of movies do you enjoy?
Do you read magazines?
What type of magazines do you enjoy?
Please select which you enjoy:
Art Galleries
Arts & Crafts
Casual Dining Clubs
Festivals & Events
Home Entertainment
Online Entertainment
Fine Dining
Musical Instruction
Theatre/Performing Arts
Painting & Sculpture
Dance & Jazz
Family/Kids Events
Musical Instruments
Sporting Events
Do you enjoy going to casinos?
Are you a runner?
How often do you run?
Do you run in marathons?
Which do you consider yourself?
Music and eBook Buyers / Book Buyers
Do you own an E-Book reader?
What type of reader do you own?
How often do you like to Read?
Which type of reading do you enjoy?
Do you purchase books or music online?
Travel Demographics:
What is your favorite kind of travel?
Do you enjoy taking cruises?
Do you enjoy gambling while cruising?
When would you be interested in taking your next cruise?
Where have you visited or would like to visit?
U.S. West Coast Europe
U.S. East Coast Canada
U.S. Midwest Australia/New Zealand
Hawaii China/Japan
The Caribbean Mexico
Latin America Middle East
Please choose the product offers that interest you most:

Golf   Performing Arts
Music & Entertainment   Real Estate
Sports   Fast Food Enthusiast
Computers & Technology   Online Shopper
Gourmet Food & Cooking   Gourmet Restaurants & Dining
People & Culture   Health & Fitness
Home Improvement   Finance
Alternative Medicine   Hobbies
Arts & Crafts   Clubs & Groups
Toys & Games   Ailments
Family Issues   Electronics
Loans   Education
Debt Relief   Home Furnishing
Books & Literature   Transportation
Business Opportunities   Pet Owner
Artwork   Food & Wine
Women's Issues    

I would like to receive additional information from third party advertisers related to my above interests.

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