*Name:
*E-Mail:	Important Sign-Up Information: If you are using a spam filter, please make sure that e-mail messages from admin@amplituderesearch.net are approved for delivery to you and that admin@amplituderesearch.net is added to your address book. Depending on your settings, you may need to look for our emails in both your regular Yahoo inbox and your Yahoo "bulk" delivery box. Thank you.
*Address1:
Address2:
*City:
*County:
*State:	Please Select One Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
*Zip/Postal Code:

*What is your gender? Male Female *What is your 4-digit year of birth (such as "1954")? Which category or categories best describes you? African American American Indian or Alaska Native Asian Spanish/Hispanic/Latino White or Caucasian Native Hawaiian or Other Pacific Islander Other *What is your household income? Please Select One Less than $20,000 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $74,999 $75,000 - $99,999 $100,000 - $149,999 $150,000 - $250,000 $250,000 - $500,000 $500,000+ *What best describes your educational level? Please Select One Completed some high school High school graduate Completed some college College degree Completed some postgraduate Master's degree Ph.D. Law degree Medical degree or D.O. *What best describes your current occupation? Please Select One Executive/Upper management Middle management Clerical/Administrative Small business owner Tech professional Doctor/Lawyer Educator Homemaker Student Other Number of employees at all locations of your company? Please Select One 1 2 to 5 6 to 10 11 to 50 51 to 100 101 to 250 251 to 500 501 to 1,000 1,001 to 5,000 5,001 to 10,000 More than 10,000 What industry is your company in? Please Select One Aerospace/Defense Contracting Agriculture and Food/Beverage Products Automotive Banking/Finance Business Services Computer Hardware Computer Software Construction/Architecture Consulting Services Educational institution Entertainment Government/Municipal Healthcare Insurance Internet E-commerce Legal Manufacturing Media Non-Profit Personal Use Pharmaceutical Retail Systems Integration Telecommunications Transportation Travel Utilities VAR Web Hosting/ISP Other Are you involved in, or have influence on, decisions about marketing/advertising purchases or the selection of marketing/advertising suppliers for your company? No Yes Are you a final decision maker on marketing/advertising purchases or the selection of marketing/advertising suppliers for your company? No Yes Are you involved in, or do you have any influence on, decisions about technology purchases (hardware or software) or the selection of technology vendors or consultants for your company? No Yes Are you a final decision maker on decisions about technology purchases (hardware or software) or the selection of technology vendors or consultants for your company? No Yes *Do you own or rent your home? Please Select One Rent Own Not Applicable *What is the size of your household ? Please Select One 1 2 3 4 5 or more *Generally, how often do you buy/lease a NEW vehicle? Please Select One Every year Every two years Every three years More than three years Not Applicable *Generally, how often do you travel by airplane for recreational (non-business) purposes? Please Select One More than 10 times a year 5 to 10 times a year 2 to 4 times a year Once a year Never/Not Applicable *Generally, how often do you travel by airplane for BUSINESS purposes? Please Select One More than 10 times a year 5 to 10 times a year 2 to 4 times a year Once a year Never/Not Applicable *Generally, how often do you eat at FAST FOOD restaurants? Please Select One All the time Once a week Once a month Once every 3 months Twice a year Never *Generally, how often do you eat at restaurants OTHER THAN fast food restaurants? Please Select One All the time Once a week Once a month Once every 3 months Twice a year Never *What type(s) of Internet connection do you have at home? Cable modem DSL Dialup T1 Wireless (only if you do not have a modem in your household) Not Sure/Other *What kind of high definition television (HDTV) set do you have at home? CRT (picture tubes) LCD (liquid crystal display) LCOS (liquid crystal on silicon) Plasma Front projection Rear projection Don’t know I/we do NOT have a high definition television set *Which of the following products do you currently consume on a regular basis? Cigarettes Coffee Non-prescription pain relievers None of the above *In past 12 months, how frequently have you purchased goods or services from an online store(s)? Please Select One Not at all 1 or 2 times 3 to 5 times 6 to 10 times More than 10 times *Do you have your own online store where you sell goods or services ? No Yes *What recreational interests do you have? (check all that apply) Attending Concerts Attending Sporting Events Auto Racing Biking Cigarettes Billiards/Pool Bowling Camping Dancing Dieting/Weight Loss Exercise/Physical Fitness Fine Art Fishing Gambling/Sports Wagering Gardening/Landscaping Golf Gourmet cooking Home improvement Music/Musician Photography Reading Swimming Tennis Timeshare vacations Travel Video/Computer Games Walking Weight Lifting None of the above *How often are you willing to participate in our surveys? Please Select One 1 time 2 times a year 6 times a year Monthly 2 times a month As often as needed *I have read and agree with the Terms of Agreement. Yes No Support | Discontinue Participation | Update Registration Information | Privacy/Security | Contact Us