Research Participant Registration Form
1.
Name
(Required.)
2.
Zip Code
(Required.)
3.
Cell Number - Enter 10 digits (no dashes, periods or parentheses)
(Required.)
4.
Email
(Required.)
5.
Age
(Required.)
18-20
21-30
31-40
41-50
51-60
61-70
71+
6.
Gender
(Required.)
Male
Female
7.
Race
(Required.)
African American
Asian/Pacific Islander
Caucasian
Latino
Other (please specify)
8.
Would you like to participate in our online surveys?
Yes
No
9.
Do you agree to receive email and text notifications about upcoming studies?
Yes
No
