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Thank you for becoming a participant!
All adults in your household must register separately. So you can be considered for all studies, fill out the form completely. When you are done, click the submit button at the very bottom of this page. If at any time you want to update your information, you can come back to this form, fill in just the required fields and the new information, then click the submit button at the very bottom of this page.
(At this time, AOC only seeks participants that reside in
Charlotte, North Carolina and the surrounding area)
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First Name
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**
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Last Name
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**
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Gender
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**
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Date Of Birth
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**
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Home Phone
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() - **
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Work Phone
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() - extension:
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Mobile Phone
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() -
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Fax
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() -
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Email Address
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Street Address
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City
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State
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Zip
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County
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Employment Status
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Select a category that best describes your primary occupation:
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Title
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Company
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Education Completed
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Race
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**
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Party Affiliation
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Marital Status
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Spouse’s Employment Status
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Spouse’s Primary Occupation
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Annual Household Income
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If you have children under the age of 18 living in your household, please provide their dates of birth and genders below:
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Child 1
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Birthdate
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Gender
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Child 2
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Birthdate
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Gender
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Child 3
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Birthdate
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Gender
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Child 4
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Birthdate
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Gender
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Child 5
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Birthdate
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Gender
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Child 6
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Birthdate
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Gender
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What type of music/radio programming do you listen to on a regular basis?
(Hold the CTRL key down while selecting to choose multiple types.)
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What is your housing type?
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Do you own a dog?
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Do you own a cat?
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Are you a vegetarian or vegan?
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Are you a sports fan? Which sports?
(Hold down the CTRL key while choosing to select multiple sports.)
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What kind of electronics are used in your household?
(Hold down the CTRL key while choosing to select multiple items.)
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Do you drink beer?
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Do you drink wine?
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Do you drink liquor or mixed drinks?
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Do you own an ATV or four wheeler?
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Do you subscribe to satellite television?
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Do you subscribe to cable television?
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Do you smoke cigarettes? If so, select the brand you smoke most often:
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Select the strength you smoke most often:
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Select the flavor you smoke most often:
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Do you smoke cigars? If so, select the type you smoke:
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Do you use moist snuff tobacco or dip? If so, select the brand you use most often:
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Select the cut of moist snuff tobacco or dip you use most often:
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Select the flavor of moist snuff tobacco or dip you use most often:
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Do you use chewing tobacco? If so, select the brand you use most often:
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Do you do your own vehicle maintenance?
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Do you exercise?
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Do you take vitamins or supplements?
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Do you purchase organic foods?
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Do you consider yourself a "Do it Yourselfer"?
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Select the stores where you regularly purchase groceries for your household.
(Hold down the CTRL key while choosing to select multiple stores.)
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Do you or anyone in your household wear corrective lenses?
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Do you or does anyone in your household suffer with:
(Hold down the CTRL key while choosing to select multiple items.)
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Do you or does anyone in your household suffer with allergies?
(Hold down the CTRL key while choosing to select multiple types.)
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How were you referred to our website?
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