If you would like to be considered for membership on our survey panels, complete the registration form below and you are will also be automatically entered in the Go Places With NFO Sweepstakes with a grand prize of $4,000 cash. In celebration of our special referral program membership drive, you will also be entered in this month's
More the Merrier Sweepstakes with a grand prize of $4000 cash. And, as a member, you become eligible to earn cash bonuses. It takes less than 5 minutes to complete the form. We keep all your information strictly confidential, using it only to select questionnaires that are appropriate for your household. Join and cast your vote for the products and services of the future. Residents of the 48 contiguous United States only please.

Contact Information

E-mail Address:
First Name:
Middle Initial:
Last Name:
Street: Your address information will be used ONLY to mail you sweepstakes prizes, cash bonuses and other gifts, and products to test.
City:
State:
Zip Code:
Phone Number: (Optional)

About yourself & your household

1. Please tell me about yourself and the people living in your home. (Do not include persons away at college, in the armed forces or persons home only on vacation.)

Yourself  
Date of Birth / /
Gender
Are you employed
What type of company do you work for?

2. What is your marital status?
    Now married
    Never married
    Divorced/Widowed/Separated

3. Including yourself, how many people live in your household?

    1
    2
    3
    4
    5
    6
    7+

4. Does anyone live in your household to whom you are related (i.e. spouse, children, parents, grandparents, etc.)?

    Yes
    No

5. Is there anyone living in your household 12 years old or younger?

    Yes
    No

6. Is there anyone living in your household 13 to 18 years old?

    Yes
    No

7. What is the HIGHEST level of education (or equivalent) you have completed.(Check one box)

    Grade school
    Some High School
    Graduated High School
    Some College-no degree
    Graduated College-Associates Degree (2 years)
    Graduated College-Bachelors Degree (4 years)
    Post Graduate Degree-MS, MA, MD, DVM, Ph.D., DDS, etc.

8. Please select the amount to show your Household's YEARLY INCOME in dollars. Combine the total income for all household members living with you - such as wages or salaries, income, from self-employment, rents, dividends, etc. - BEFORE tax deductions.

9. IMPORTANT - To ensure the person referring you to our interactive consumer research panel is properly credited, we appreciate you supplying both his/her NFO member number and email address.  You must include member number and/or email address of the person referring you in order for him/her to earn credit.

    Referring Member Info:

    Membership Number      E-mail Address

Thank you for completing this registration form. By pressing the "Click here once to send responses" button, you'll be entered in our Go Places with NFO Sweepstakes and this month's More the Merrier Sweepstakes, each with a grand prize of $4000 value. Look for an email from us within the next couple of days describing details of both contests and telling you about ways to earn cash bonuses.

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Phone: (800) 537-4097 Fax: (419) 481-8595
E-Mail: carol@nfoi.com

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