PAR Market Research

Home

Join Our Panel

Thanks for considering joining the PAR Research Panel. From time to time participants will receive offers to participate in research projects of various sorts. Many of the projects offer compensation for participation. Incentives vary. We promise you'll find them all interesting!

First Name
Last Name
Street Address
Address (cont.)
City
State
Zip
Home Phone
E-mail

Age

	Under 18
	18-24
	25-34
	35-44
	45-54
	55 or over

Gender

	Male
	Female

Race

	African-American
	American Indian, Eskimo
	Asian, Pacific Islander
	Caucasian
	Hispanic
	Other
	Unknown/Refused

Education

	Less than high school
	High school diploma/GED
	Some college, no degree
	College graduate
	Unknown/Refused


Occupation

Married (If Yes, please enter Spouse information)

	Yes
	No

Spouse Name

Spouse Age

	Under 18
	18-24
	25-34
	35-44
	45-54
	55 or over

Spouse Education

	Less than high school
	High school diploma/GED
	Some college, no degree
	College graduate
	Unknown/Refused

Spouse Occupation

Children at home

	Yes
	No

Child 1 Year of Birth

Child 1 Gender

	Male
	Female


Child 2 Year of Birth

Child 2 Gender

	Male
	Female

Child 3 Year of Birth

Child 3 Gender

	Male
	Female

Child 4 Year of Birth

Child 4 Gender

	Male
	Female

Activities/Hobbies

	Arts/Crafts
	Archery
	Basketball
	Baseball
	Bowling
	Computers
	Electronics
	Football
	Reading
	Soccer
	Travel
	Unknown/Refused

Pets

	Yes (Specify)
	No

Occasionally we need people with specific health issues. Which of the following health conditions apply to you or anyone in your immediate household? (check all that apply)

	No health concerns/problems
	Allergies
	Asthma/COPD
	Cancer
	Diabetes
	Heart condition
	High cholesterol
	Hormone Replacement Therapy
	Hypertension/high blood pressure
	Mental health issues
	Sleep disorder/sleep apnea
	Don't know/Refused
	Other (specify)

Favorite radio station?

#1
#2
#3

Favorite food?

Favorite beverage?

For all your market research needs.