* First Name

* Last Name

E-mail

* Address

* City

* State
CALIFORNIA ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

* Zip Code

* Home Phone (Ten Digits)

Alternate Phone

* Date of Birth (mm/dd/yy)

* Gender
Select Gender Female Male

Referred By

Employment Status
Select Full Time Homemaker Not Working Part Time Self Employed Retired Student

Occupation (e.g. Accounting)

Industry (e.g. Television)

Income
Select Under $30,000 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $109,999 $110,000 - $129,999 $130,000 - $149,999 $150,000 - $174,999 $175,000 - $199,999 $200,000 - $249,999 $250,000 - $299,999 $300,000 - $399,999 $400,000 or more

Education
Select Less than High School High School Grad. Some College Associates Degree Technical / Trade School College Grad. Post Grad. Doctorate/M.D.

We often conduct toy research with children. If any  children, 17 or younger, are living in the household, please  indicate name, gender, and date of birth below.
 

Name
Child 1

Birthdate
(mm/dd/yy)

Gender

Select Gender Female Male

Name
Child 2

Birthdate
(mm/dd/yy)

Gender

Select Gender Female Male

Child 3

Select Gender Female Male

Child 4

Select Gender Female Male

Hobbies

Household Vehicles:
Make (e.g. Ford)	Model (e.g. Mustang)	Year
Vehicle #1:
Vehicle #2:
Vehicle #3:

Who is your Internet service provider?

What is your Internet connection speed?
Select Dont Know Less than 28.8 Kbs 56Kbs ISDN DSL Cable T1 Fiber Optic Other

Types of Computers

Hours of TV  watched per week:

Hours of Prime Time TV (8-11pm) p/week:

Video Game (Console) Models

My favorite TV shows are (List all):