Please read and answer each question carefully 1. Are you eighteen years of age or older? Yes No

2. Please indicate your gender 1- Male 2- Female

3. Are you a Pennsylvania resident? Yes No

4. Thinking about the crime in the Erie area over the past 5 years, would you say it has... Decreased a lot Decreased a little Stayed the same Increased a little Increased a lot

5. Thinking of public schools in the Erie area over the past 5 years, would you say their quality has... Decreased a lot Decreased a little Stayed the same Increased a little Increased a lot

6. Which hospital in the Erie area do you prefer to go to for your health care needs? 1- Hamot Hospital 2- Saint Vincent 3- Millcreek Community 4- Other   Please specify

7. Are you registered to vote as a democrat, republican or some other party? 1- Democrat 2- Republican 3- Other party 4- Not registered 5- Registered, but unsure of party

8. Which bank do you prefer for your banking needs? 1- First National 2- Marquette 3- Citizens 4- North West 5- PNC 6- Credit Union (any) 8- Huntington 15- Erie Bank 16- First Niagara None of the above

9. Moore Research, a locally owned company, has been in business for over 40 years, providing people in the area with the opportunity to give their opinions about the everyday products and services they buy and use. We are continually looking for people to participate in our studies. Would you be interested in participating in future research studies where you are paid for your time and opinions? 1- Yes 2- No

10. Which of the following products have been purchased and eaten by anyone in your household in the past 3 months? 26- Frozen Pizza   17- Cottage Cheese 27- Frozen Dinner/Entrees   25- Apple Juice 32- Frozen Skillet Dinners   35- Vodka 12- Orange Juice   36- Whiskey 13- Bagels   37- Rum 15- Coffee   None of the above

11. The following is a list of products that some women use.  Please check any products on this list that you, yourself are currently using. 1- Concealer   10- Facial Cleanser 2- Mascara   11- Body Moisturizer 3- Eye Shadow   12- Eye Cream 4- Lipstick   13- Hair Conditioner 5- Foundation Makeup   14- Leave in Hair Conditioner 6- Blush   21- Body Glow 15- Loose powder   30- Liquid Eye Liner 16- Pressed powder   35- Mechanical Eyeliner 22- Lipgloss   32- Face Primer 8- Facial Moisturizer   0- None of the above

12. Is your foundation... 17- Cream to powder 18- Liquid foundation 19- Mousse foundation 20- Cream/Creme in a jar 31- Mineral Make-up

13. What shade of foundation do you normally wear? Light Medium Dark

14. For classification purposes only...  What is your marital status? 1- Married 2- Living with significant other 3- Widowed 4- Single/Divorced/Separated

15. In which of the following category does your age fall? 1- age 18-24 2- age 25-34 3- age 35-44 4- age 45-54 5- age 55-64 6- age 65 or over 7- Refused

16. What is your Date of Birth? MM/DD/YYYY

17. What is the age of the other adult in your household? 0- There is no other adult 1- age 18-24 2- age 25-34 3- age 35-44 4- age 45-54 5- age 55-64 6- age 65 or over 7- Refused

18. What is his/her Date of Birth? MM/DD/YYYY

19. In just a few words, what is your occupation (or job title)?

20. Please choose from one of the following areas to describe your profession... 1- Management/Professional 2- Technical 3- Clerical/Secretary 4- Salesperson 5- Retired 6- Homemaker 7- Unemployed 8- Blue Collar 10- Self employed 11- Student 12- Other 14- Disabled 15- Military 13- Refused 16- Service (Restaraunt Server, Customer Service... etc.)   Please Specify

21. What is the highest level of education you have completed? 1- Some high school or less 2- Completed high school 3- Some college or technical school 4- Completed College 5- Graduate Studies and beyond Refused

22. What is your ethnic background? 1- Caucasian 2- African American 3- Hispanic 4- Other 5- Asian   Please specify

23. Which of the following categories best describes your total family income? 1- Less than $15,000 2- $15,000- $24,999 3- $25,000- $34,999 4- $35,000- $49,999 5- $50,000- $64,999 12- $65,000- $74,999 13- $75,000- $100,000 14- Over $100,000 6- Don't Know 7- Refused

24. Moore Research often conducts fun product and taste tests for kids to participate in.  Do you have any children that are 17 or younger, living in your household? Yes No

25. How many children do you have that are 17 or younger and currently living in  your household? 1 2 3 4 5 6 or more

26. Child's Gender:   Male   Female     Child 1       Child 2       Child 3       Child 4       Child 5       Child 6

27. Date of Birth (MM/DD/YYYY)

28. Child's Name:

29. Do you  have any children in diapers? Yes No

30. What brand diaper do you use most often? 1- Huggies 2- Pampers 3- Luvs 4- Other

31. Do you have a computer at home? 1- Yes 2- No

32. Do you have access to the internet?  If yes, what is your email address?

33. Have you or has anyone in your household played any Lottery/Instant games in the past year? 1- Yes 2- No Don't know

34. Of which online networking communities would you consider yourself an active member? 1- Facebook 2- Myspace 3- Second life 4- Twitter 5- LinkedIn 6- Habbo 7- Xanga 0- None 8- Other   Please specify

35. Moore Research frequently uses Facebook to recruit study participants. Are you currently a Fan of Moore Research on Facebook? Yes No If you would like to be the first to know about our upcoming studies, click here and select to become our Facebook Fan!

By submitting your information here, you acknowledge that Moore Research may contact you about participating in our research studies. Your information will never be sold or shared with any third parties and no sales will take place in any of our studies.
Name (FIRST AND LAST)   Street Address   City		State   Zip Code		Phone (home) Example: 814-835-4100   Phone (cell) Example: 814-835-4100   Today's Date
Thank you for your time and opinions! We will be in contact with you soon!