Tell us about yourself

Elliott Benson Research is an organization interested solely in collecting opinions. As a participant in one of our studies, you could help to create new products, services, advertising, or possibly impact decisions in the local government, and the best part is that you�ll be paid for your opinions!

Please keep in mind that some of our clients seek participants who meet very specific needs, so the more we know about you, the more likely we are to contact you for our studies!

We keep all information strictly confidential and we never sell our database to outside sources.
 

We need to know if you are signing up for the first time or if you are updating information.
(Please select one)

 

I am a new participant to the database.

 

I am currently in the participant database, but need to update my information.
 

We conduct research on a variety of topics. Please select your preference:

(Please select one)

 

I would like to be contacted for any studies that I may qualify for.

 

I would like to be contacted ONLY for studies that involve my occupation/area of professional expertise.

 

 

*How did you hear about our research studies?

 

 

CONTACT INFORMATION:  

*First Name:

*Last Name:

*Home Phone:

Work Phone: 

 EXT:

Cell Phone: 

*Gender:

*Date of Birth: 

*Home Address:

*City:

*State:

*Zip:

County (CA Only) :

Country:

*Email:

 

 

DEMOGRAPHIC INFORMATION:

Primary Language:

Secondary Language/s:
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Marital Status:

Education Level:        

Political Party:

Ethnic Background:

Household Income:

 

 

EMPLOYMENT INFORMATION:

Employment Status:

Occupation Type/Level:

Industry:

Number of Employees (All Locations):

Exact Job Title:

Employer:

Do you travel for work? 

 

 

HOUSEHOLD INFORMATION:

Do you?

 

 

 

Please include information for any children under 18 living in your home.

Child #1:

Gender

Birthdate

Child #2:

Gender

Birthdate

Child #3: 

Gender

Birthdate

Child #4: 

Gender

Birthdate

Child #5:  :

Gender

Birthdate

Child #6: 

Gender

Birthdate

 

 

LIFESTYLE INFORMATION:

Do you smoke cigarettes?

Do you have a pet?
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Type(s) of Vehicles owned:
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Sexual Orientation: 

Favorite Music:
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Green Lifestyle:
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Online Activities:
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Technology Owned:
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Health Conditions:
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Which statement best describes your approach to learning about and trying new technology? 

Are you currently active in any of the following types of organizations?  That is, do you regularly attend meetings, donate money or time, or are you a current or previous leader in any of these organizations?
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