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Step 1 - To see if you qualify, please provide the following information.

       
* Birthday: 
     
* Gender: 
     
* How many children/stepchildren aged 0-19 live in your household?
* How old are the children/stepchildren living with you?

Using the scale below, indicate how much you agree or disagree with each of the following statements:

Strongly
Disagree		 Disagree Slightly
Disagree		 Neither Slightly
Agree		 Agree Strongly
Agree
* I like to learn about new things so I can share them with others.
* I do a lot of research before making a major purchase.
* I am reluctant to try new products until I can find out whether others think they are any good.
Please complete all fields.

* Denotes required information

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