Advantage Research Services, Inc. conducts marketing research projects on a variety of different subject's. We will be inviting you to participate in future projects, and if you qualify and participate, you will be paid for your time. The paid incentive amounts range anywhere from $25.00 - $100.00, depending on the type of project.

This is a confidential database that is maintained strictly for market research purposes (never sold). We guarantee that this information will only be used by Advantage Research Services, Inc. to offer you the opportunity of participating in market research studies at your convenience and for a paid incentive and/or free products to test.

We invite you to fill out the form below to be added to our database so that we may contact you in the future to participate in a market research study.

REMEMBER: When you get a call from Advantage Research, IT IS NOT A SALES CALL - WE ARE JUST LOOKING FOR YOUR OPINIONS!

Please take a minute to add yourself to our database.

Database

Instructions

Answer questions as they relate to you. For most answers, check the box(es) most applicable to you or fill in the blanks

Please provide the following (*required)

First Name*

Last Name*

Occupation*

Address*

City*

State / Province*

Postal Code*

Phone*

Email*

General Info

1.	Which county do you live in? *Required

2.	Your Year of Birth *Required

3.	Your Gender *Required

	Female
	Male

4.	Your Ethnicity

	Asian/Pacific Islander
	Black/African American
	Caucasian
	Hispanic
	Native American

5.	Marital Status?

	Single
	Married
	Divorced
	Other:

6.	How many children do you have?

	0 (Skip to Q. 8)
	1
	2
	3
	4
	5
	6+

7.	Children's Birth Years

	(Select all that apply.)
	Male
	Female
	2002
	2001
	2000
	1999
	1998
	1997
	1995
	1994
	1993
	1992
	1991
	1990
	1989
	1988
	1987
	1986
	1985

8.	Your Highest Education

	High school
	Some college
	Undergraduate degree
	Some graduate school
	Technical School
	Graduate degree
	Masters Degree

9.	Your Annual Household Income

	Less than $25,000
	$25,000 - $50,000
	$50,001 - $75,000
	$75,001 - $100,000
	More than $100,000

Additional Info

10.	Do you have Health Care?

	Yes
	No

11.	How many vehicles you have in your Household?

	0 (Skip to Q. 13)
	1
	2
	3
	4
	5
	6+

12.	Types of Vehicles

	(Select all that apply.)
	SUV/Van
	Truck
	Compact
	Full-Size
	'00/Newer
	Lease

13.	Fast Food Restaurants

	(Select all that apply.)
	McDonalds
	Burger King
	Wendy's
	Other:

14.

Pets

	(Select all that apply.)
	Cat(s)
	Dog(s)
	Bird(s)
	Other

15.	Favorite Radio Station 1

16.	Favorite Radio Station 2

17.	Favorite Radio Station 3

18.	Are you a Registered Voter?

	Yes (Skip to Q. 19)
	No (Skip to Q. 20)

19.	Partisanship?

	Democrat
	Republican
	Independent

20.	Favorite Grocery Store?

21.	Long Distance Company

22.	Heating Company

23.	Electric Company

Lifestyle

24.	Check all that apply:

	(Select all that apply.)
	Cell Phone
	Health Conscious
	Beer
	Wine
	Liquor
	Camper
	Smoker
	Chew Tobacco
	Do-It Yourself-er
	Collector
	Pool/Hot Tub
	Vegetarian
	Lottery
	Diet Pop
	Regular Pop
	Computer(s)
	Internet Service
	Gardener
	Exercise Regularly
	Diagnosed Allergies
	Diabetic
	Home-Owner
	Cable TV
	Digital Cable
	Boat Owner
	Warehouse Member (Sam's)
	Satellite Dish
	Golfer

If you have any Questions or Comments: Andrew G Riemersma