Panelist Registration Questions

Thank you for your interest in participating in our research. Please take the following survey that will enable you to be a member of our SurveyWisconsin e-Panel.

1) Please provide us with your current contact information.

First Name
Last Name:
Address:
City:
State:
Zip Code:

2) Please enter the phone number, including your area code, where we can reach you to participate in research:

Phone number:

3) Please supply us with an accurate email address. This email address will be used for-
- Creating your rewards account
- Sending you a password to access your rewards account
- Future emails to participate in surveys and focus groups

email:

4) If you were referred to our panel by a friend, please enter their first and last name in the space provided so they can receive their referral bonus!

Name: