Test Participant Sign-Up Form

By completing and submitting this form, you will be registering yourself as a potential candidate to use and evaluate various products from websites to laptop computers. To ensure that we have the appropriate participants for the products to be tested, it is essential that you complete all of the fields on this form and that your responses are accurate. Note that the terms of Usability Sciences' Privacy Policy prohibit children under the age of 14 from registering.

Please tell us about yourself: (* = Required Field)

Please select the option that best describes your visit today: *

This is my first time to enroll:

I am enrolled, and I am just updating my information:

How Did You Hear About Us?

Contact Information Salutation:
First Name: *
Last Name: *
Primary Daytime Phone: * --
Cell Phone: * --
Home Phone:    --
Primary Email: *
(Used for all communication)
Backup Email:
(Used if your primary email is not functioning)

Address Information Home Country: *
(Only US-based testers are needed at this time)
Home Street Address 1: *
(Street Address, P.O. Box, Company Name, etc.)
Home Street Address 2:
(Apartment, Suite, Unit, Floor, Building, etc.)
Home City: *
Home State: *
Home Zip/Postal Code: (ex: 75038): *

Demographic Information Gender: *
Ethnicity: *
Marital Status: *
Your Birthday: * Month: Year:
Place of Residence: *
Yearly Household Income (combined): *
Number of Children at Home: *
Highest Level of Education: *

Work Information Employment Status: *
Company:
Title:
Company Industry:
Num of Employees in Company:
Job Function:
Job Description:

Computer Information How often do you Purchase Online?
Types of Internet Purchases?

Do you have a Home Computer?
(check box for "yes")

Hours of Internet at Home per week:

Do you have a Work Computer?
(check box for "yes")

Hours of Internet at Work per week:

Computer/Internet Experience

Please rate yourself using the following definitions that BEST describes your experience.

Beginner - I am fairly new to using computers and the Internet, so I request technical support from my friends, family, or a help service very often.

Intermediate - I am somewhat comfortable using my computer, including the Internet, and can solve some minor problems myself. However, I request help fairly often.

Advanced - I am comfortable using my computer and the Internet. I can solve some moderately complex problems without assistance, but occasionally need some help.

Expert - I consider myself to be a technology expert, and rarely need help with technology issues.

Level of Computer/Internet Experience: *

Additional Information

Though our projects may occur in different cities around the world, the majority take place at our corporate headquarters in Irving, TX, a suburb of Dallas, TX.

Can you Test in the Dallas (Irving) area? *

Thank you for answering these questions. By submitting your information, you will enter our database as a test member. You may receive frequent emails notifying you of upcoming tests that you might qualify for as well as updates concerning your participation.

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