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Welcome - we're glad you're here! By completing this form, you will be entering yourself in one of the Internet's premiere market research panels. As a panelist, you will represent consumers' needs and opinions to companies worldwide. Your participation and feedback will shape many companys' products and services and help them develop new ideas to better serve your needs.

If you have any problems with this questionnaire or questions regarding our purpose, please email us. We will be happy to answer any questions you may have.

Note: It is important you carefully read each question and give a thoughtful answer. The information we collect here is used to match panel members with appropriate surveys. All information is held CONFIDENTIAL. Once you complete this registration form and click the submit button, you should get a "Thank you" screen. If you do not get the "Thank you" screen, try clicking the submit button again.

Let's get started!

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  Gender Year born
Child 1 Male Female
Child 2 Male Female
Child 3 Male Female
Child 4 Male Female
Child 5 Male Female
Laptop Computer Sony Playstation (PS2 or PS3)
Desktop Computer Xbox video game console
DVD Player Other Gaming Console
Recordable DVD player A House
Recorder box provided by cable company A Condominium or Townhouse
Personal Video Recorder/Digital Video Recorder
(i.e. TiVo/Media Center PC/digital video
Home theater system Car (sedan, coupe)
HDTV (High Definition TV) Sports car
Cell Phone SUV
PDA RV
MP3 Player Off-road motorcycle
iPod On-road motorcycle
Gameboy Advance ATV
Nintendo Gamecube Satellite Radio
PC Gaming GPS system in automobile



ABC Fox Sports Net
Animal Planet Fox Sports World
BBC America FX
BET HD Theater
Cartoon Network HGTV
CBS Lifetime
CNN MTV
Comedy Central MTV2
Court TV National Geographic Channel
Discovery Nickelodeon
Discovery En Espanol Science Channel
Discovery Health Speed Channel
Discovery Home and Leisure TBS
Discovery Kids TLC
Discovery Times TNT
Discovery Wings Travel Channel
FitTV Turner Movie Channel
Food Network TV Land
Fox Movie Channel VH1
Fox News Channel None of these
1 = Strongly agree
2 = Somewhat agree
3 = Neither agree nor disagree
4 = Somewhat disagree
5 = Strongly disagree
  1 2 3 4 5
I'm typically the first or second person I know to try new things; I consider myself a real independent thinker and experimental
I am frequently the one doing the newest thing(s) first
When I have a great or an awful experience with a new brand, product, service, vendor, venue, anything, I tell lots of other people
I am often consulted by my peers for counsel and recommendation on a range of topics (e.g., vacation destinations, restaurants, movies)
I trust what I read in newspapers and magazines, and believe what I hear on television and radio
I consider myself far behind the times and not very engaged in either consumerism or pop culture.
Automotive Sports (participation)
Cooking/entertaining at home Sports (as spectator/fan)
Dining out Popular culture
PC's and other computer equipment Personal finance
Mobile communications products Health and medical
Consumer electronics (TV, audio, etc.) Do it yourself home projects
Home furnishing and decorating Fitness and Exercise
Entertainment (movies, television, live music, etc) Film
Travel Theatrical and cultural events
Fashion and style Television
Parenting    
Allergies
Arthritis
Asthma
Frequent bladder urges and/or leakage
Cancer
Depression
Diabetes
Heartburn
Heart problems
Hypertension
Migraines
STD
Stomach problems
Allergies
Arthritis
Asthma
Frequent bladder urges and/or leakage
Cancer
Depression
Diabetes
Heartburn
Heart problems
Hypertension
Migraines
STD
Stomach problems
Cat(s)
Dog(s)
Fish
Small domestics (mice, rats, hamsters, guinea pigs, etc.)
Horses
Other
None
Running/jogging
Cycling
Swimming
Gym classes and workouts (member of a gym)
Tennis
Other racket sports
Surfing
Scuba diving

RESPONDENT CONFIDENTIALITY AGREEMENT

Esearch.com, Inc. online panel participants are required to read and indicate acceptance of the following before being accepted as registered online panel members.

I agree to participate in Esearch.com's studies. I understand that I will be asked to evaluate ideas, concepts, products, services, etc. and as such, I will be privy to Company Confidential information (Company being Esearch.com and its Clients, Agents, Representatives and Associates). I understand that Esearch.com can remove me from the panel database at any time if they feel I have abused my privilages as a panel member or provided false information (on this form or any survey.) As a condition in becoming a registered online panel member, I agree to the following:

  • I will sign up to take surveys under one email address only. The information I have provided on this registration form is accurate and honest.
  • I will never provide false information on a survey. I will read all questions and answer honestly.
  • I will never attempt to take a single survey multiple times.
  • I will not disclose to others, or use for any purpose other than for the performance of the studies, any information relating to the products, concepts or ideas disclosed to me during the Studies.
  • I understand that my comments and opinions will be used for market research and educational purposes only.
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By clicking the Submit button, I certify that I accept and agree to the terms and conditions of the Respondent Confidentality Agreement.

I understand that I will receive a registration email and then periodic email survey invitations from Esearch.com (sent via esearch@esearch.com). http://www.esearch.com/privacy