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* 1. Murray Hill National, a market research company, will be in your area soon conducting PAID RESEARCH. We would like to invite you to receive notifications on all studies that might apply to you.  All of our research will pay you an incentive.  Cash and / or Rewards.   We will input your information into our database and contact you if you meet specific criteria.  To get started we require at a minimum your contact info.  We are asking a host of questions that will assist us in narrowing down which studies / research best suite your profile.  We are excited to work with you.

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* 2. How many hours of TV do you watch per week?

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* 3. Which category below includes your age?

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* 4. What is your gender?

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* 5. What is your ethnicity?

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* 6. In what industry do you work?

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* 7. What is your profession?

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* 8. Are you a Healthcare Professional? What is your specialty?

  Nurse CNA NP PA PCP Other Specialty I am not a healthcare professional
Yes
No

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* 9. Please pick all that apply

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* 10. Please check any of the following that apply to you:

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* 11. Have you ever been diagnosed with any of the following or had a diagnosis confirmed by a physician? Please select all that apply.

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