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SHARE YOUR OPINIONS AND GET REWARDED
AT SURVEYS.COM!
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Membership is free and sign-up is
easy. It only takes a few minutes and you can opt out at any time. Tell us what
you think - we value your opinion!
Become a panel member and...
- Share your opinions and influence decisions on a range of topics such as: current
events, entertainment, politics, and new & existing products and services.
- Just complete the registration profile and start being rewarded! Points are awarded
for all survey participation and can be redeemed for lots of great items! So sign
up now and get rewarded!
All information is strictly confidential and privacy is guaranteed. Your name will
never be sold, exchanged, or distributed to any other party. See our
Privacy Policy for complete details.
All items marked with an asterisk (*) are required.
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What languages do you speak? *
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Preferred Language *:
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*
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Country of Residence *:
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*
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Account Creation:
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E-mail Address *:
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* *
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Verify E-mail Address *:
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* *
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Password *(min4, max20):
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* *
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Confirm Password *:
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* *
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Contact Information:
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First Name *:
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*
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Last Name *:
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*
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Address 1:
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(optional)
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Address 2:
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(optional)
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City / Town *:
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*
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State*:
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Zip Code *:
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*
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Phone number :
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Mobile phone number:
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We often conduct other surveys, for example to try out new
products, by mail or telephone. Can we call or mail you if we have this opportunity?
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Personal Information:
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Gender *:
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*
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Birth Date *:
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* * *
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Marital status *:
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*
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Highest level of Education completed
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*
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Your employment status *:
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*
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Other:
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If working, Industry employed in
*:
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Other:
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If working, Type of Employment *
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Ethnic Origin *:
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*
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In the last week, on how many separate occasions have you
used the Internet, including e-mail, world wide web and other on-line services?
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*
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In the last 4 weeks, how many times have you used the World
Wide Web from home, work or elsewhere in order to purchase (by which I mean, pay
for) products and services? *
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*
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Household Information:
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What is your household's combined yearly income? *
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*
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Who owns the property you live in
*?
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*
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Counting yourself and any children, how many people are
living in your household? *
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*
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Are you a parent of a child under 18 (by birth or adoption)
currently living in your household? *
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*
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How many children do you have living in your household who
are:
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Under 5 years old *
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5 to 8 years old
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9 to 11 years old
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12 to 15 years old
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16 to 17 years old
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