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Participate in Research   Marketing Workshop   Focus Groups   Surveys   Brand Strategy   Mystery Shopping   Public Relations   Web Site Usability   Healthcare Research	Your Message Power Marketing and Research needs your help! The clients we work with are looking for the opinions of people just like you. By joining our market research database — Power Panels — you will help companies improve their products and services. If you would like to participate in future research projects, please complete the form below and submit. We will add your name to our database and contact you when research projects are scheduled. For more details please read our research FAQ. Please note that this information will be kept confidential and will not be sold to anyone. Please see our privacy policy for more information. First name: Last name: Address line 1: Address line 2: City: State: Zip code: Home phone: Work phone: Cell phone: E-mail: (Your e-mail address will be kept private) Gender: Select one Male Female Other Age: Select one Under 18 18-24 25-29 30-39 40-49 50-64 65 and over Marital status: Select one Married Single Divorced Widowed Ethnicity: Select one American Indian or Alaskan Native Asian Indian Black or African American Chinese Japanese Korean Other Asian Hispanic/Latino Middle Eastern Native Hawaiian or other Pacific Islander White Education: Select one Some high school or less High school graduate College graduate Post graduate Residence: Select one Homeowner Renter Other Employment: Select one Full time Part time Student Retired Unemployed Annual household income: Select one Less than $25,000 $25,000-$49,999 $50,000-$74,999 $75,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 or higher Number of children under age 18 in your household: Select one None 1 2 3 4 5 or more Number of adults age 18 and over in your household: Select one 1 2 3 4 5 or more Number of vehicles you own: Select one 1 2 3 4 5 or more Manufacturers (select all that apply): BMW Ford GM Chrysler Honda Hyundai Infiniti Lexus Toyota Volkswagen Volvo Other: Sporting activities (select all that apply): Attending organized sporting events Participating in organized sports Bicycling Golf Racket sports Running Skiing Walking Water sports Yoga Other: Cultural activities (select all that apply): Theater Museums Music Travel Other: Outdoor activities (select all that apply): Camping Canoeing/Rafting Fishing Hiking Hunting Other: Leisure/community activities (select all that apply): Cooking Dancing Movies Politics Reading Volunteering Other:

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