PANEL ENROLLMENT Full name*E-mail*Phone Number*AddressCity, State*Zip Code*Age Under 18 18-24 25-34 35-44 45-54 55+GenderMaleFemaleRace or Origin Black or African-AmericanWhiteAsianNative American or Alaskan NativeHispanic/Latino/spanish OriginNative Hawaiian or Other Pacific IslanderMulti-Race BackgroundRelationship status SingleIn a Relationship (Not married)MarriedDivorcedSeparatedChildrenNone1-23-56+Highest Education level completed Some high schoolHigh school graduateSome collegeAssociate’s DegreeBachelor’s DegreePost-Graduate Degree (Master’s Degree/PhD/JD)Annual Household IncomeLess than $29,999$30,000 – 44,999$45,000 – 59,999$60,000 – 74,999$75,000 - $99,999$100,000 - $174,999$175,000+Availability (check all that apply) Monday – Friday: 7am - 12noon Monday – Friday: 12noon - 5pm Monday – Friday: After 5pm Saturday: Morning/Afternoon Saturday: Evening Sunday: Morning/Afternoon Sunday: EveningInterested opportunities (check all that apply) Face-to-Face interviews (1-on-1) Group interviews Online surveys Online interviews (Google Hangout, Skype, etc) Product usage testing Special events/promotionDo you own (or have access to) a smartphone? Yes NoDo you own (or have access to) a web camera? Yes No