Market Research Interview Registration
 

Welcome to TAi New Jersey.  Please answer the following questions in order to submit your name to TAi for potential use in upcoming surveys.  Although we don't require you to answer all the questions below, the more information you provide, the better your chances of  participating in an upcoming survey.

Once you register, we will try to match you up with the first appropriate project.  You will be paid an honorarium of $35 or more depending on the subject and length of the project.  Most research projects are conducted at our office in Teaneck. 

You must be able to get to our Teaneck, N.J. office in order to participate in these projects.  You will need to bring photo ID with you when asked to participate in an interview.

You must be 18 or older.  It's not that we don't like kids. We do. In fact, we were kids once. But federal law limits who we can collect information on. Thanks.
   Please fill out the online form below, or print the form and mail it to:

TAi New Jersey 
The Atrium at Glenpointe 
Suite #67 
400 Frank Burr Boulevard 
Teaneck, NJ  07666

NOTE: This information is for market research purposes only. You will not be solicited for any sales purpose whatsoever and your name, address or phone number will not be made available to any sales or telemarketing company.  If you are concerned about your privacy, you may see our security statement.

(Items with an asterisk (*) are required for registration.)
 
First Name *
 
Last Name *
 
Street Address
 
City
 
State
 
Zip Code
 
County
 
Home Phone
(including area code, please) *
 
Work Phone
 
Cell Phone
 
E-mail Address *
     (enter "NA" if you don't have e-mail)
 
Date of Birth *   
   (Sorry, but you must be over 18) 
 
Gender * Male Female
 
Housing Type
 
Annual Household Income (before taxes)
 
Highest Level of Education Completed *
 
Marital Status
 
Ethnicity *
 
Employment Status *
 
How are you registered to vote?
 
Occupation
 
Industry
 
Spouse's Occupation
 
Spouse's Industry
 
How many children under the age of 18 are in your household? *
 
Please give information about the children in your household  Gender        Birth Date
    First Child     
    Second Child     
    Third Child     
    Fourth Child     
    Fifth Child     
    Sixth Child     
 
Do you suffer from any of the following medical conditions?
       Select all that apply.
Please scroll down to view additional selections.  Hold the Control <Ctrl> key while clicking to select multiple languages. To remove a language, hit <Ctrl> while clicking again.
 
Are you a caregiver to a friend or family member with any of these conditions? If so, select the conditions that the person you provide care for experiences.
       Select all that apply.
Please scroll down to view additional selections.  Hold the Control <Ctrl> key while clicking to select multiple languages. To remove a language, hit <Ctrl> while clicking again.
 
Who do you provide care for with the above conditions?
       Select all that apply.
Please scroll down to view additional selections.  Hold the Control <Ctrl> key while clicking to select multiple languages. To remove a language, hit <Ctrl> while clicking again.
 
If you feel that you need to lose weight, how many pounds do you need to lose?
 
Select the following items if you currently use/wear them.
 
What company provides your cable service?
 
Pets