LewisClarkBoone Market Intelligence

6600 Six Forks Road
Suite 202
Raleigh, NC 27615 USA

phone: 800-860-0665
fax: 800-864-5157

Thank you for your interest in joining our consumer research panel. Please complete the information below and click on the submit button. All information you submit is confidential. It will be used only in conjuction with opportunites to participate in survey research projects. Your information will not be supplied to third parties for any purpose.

Please note, you must be 13 or older to register. While most of our surveys are limited to US residents, we do occasionally conduct surveys of international audiences. Individuals outside the US are welcome to register.

Your name (required):
Your email: (required)
Your address:
Your city:
State/province/region:
Zip/postal code:
Country:

Please check the types of research you would like to participate in:

Online/email	Telephone	Focus groups
Mail	In-person interviews

The following questions are optional, but your answers will help us to match you up with appropriate survey opportunities.


	Your gender:	Male	Female


Your age:	18 - 21	40 - 49	70 or older
	22 - 29	50 - 59
	30 - 39	60 - 69


	# of adults (18 or older) in your household, including yourself: #:

# of children (under 18) in your household: #: No children under 18 live in household


	Are you, or a member of your immediate household, employed in the market research industry?
	Yes	No