Panelist Registration Questions

Thank you for your interest in participating in our research. Please take the following survey that will enable you to be a member of our marketing research panel.

Beginning with this survey (you get 200 CitySurvey Rewards Points for your answers today), you will be awarded points which you can redeem and exhange for gift certificates and merchandise. In addition you could qualify to receive monetary stipends for participating in research sessions, testing products at focus facilities, or in your home.

1) Please provide us with your current contact information.

First Name
Last Name:
Address:
City:
State:
Zip Code:

2) Please enter the phone number, including your area code, where we can reach you to participate in research:

Phone number:

3) Please supply us with an accurate email address. This email address will be used for-
- Creating your rewards account
- Sending you a password to access your rewards account
- Future emails to participate in surveys and research sessions

email:

4) If you were referred to our panel by a friend, please enter their first and last name in the space provided so they can receive their referral bonus!

Name: