Signup -Media Science

Welcome to The Media Panel at MediaScience!

Participation in research studies with MediaScience is completely voluntary. Your information will be saved in our Media Panel database and you will be contacted via phone and/or e-mail when you are eligible for a study. Eligibility is not guaranteed. Panel members earn AMEX or VISA gift cards for research participation, as well as other incentive rewards for study-related programs.

We understand the sensitive nature of these details for some people, but the information is important for selecting participants who represent a wide range of the American population. This information will only be used for research purposes and will not be shared with any third parties. For more details, please see our privacy policy.

* = required
Invitation Code*

Contact Information

First Name*

Middle Name

Last Name*

Phone* Please enter your 10 digit number.

Email*

Address*

Address 2

City*

State*

Zip*

Demographic Profile

Gender*
Date of Birth*
What is the level of your highest educational qualification?*
- Grammar school
- High school or equivalent
- Vocational/technical school (2 year)
- Some college
- Bachelor's degree
- Master's degree
- Doctoral degree
- Professional degree (MD, JD, etc.)
- Other qualification
- Prefer not to answer
What is the range of your pre-tax yearly household income?*
- No Income - $0/year
- Under $20k/year
- Up to $45k/year
- Up to $70k/year
- Up to $95k/year
- Up to $120k/year
- Up to $145k/year
- Over $145k/year
- Prefer not to answer
What is your main occupation?*
- Manager or administrator
- Professional (Doctor, nurse, lawyer, secretary, etc...)
- Tradesperson (Electrician, plumber, etc...)
- Retail (Cashier, stocker, etc...)
- Industrial Laborer (Machine operator, construction worker, etc...)
- Technical (Computer technician, graphic designer, programmer, etc...)
- Government
- Education / Teaching
- Stay at home parent / Household duties
- Student
- Retired
- Not currently employed
- Other occupation
- Prefer not to answer
What ethnicity are you?*
- White/Caucasian
- African American
- Hispanic
- Asian
- Native American
- Pacific Islander
- Other
- Prefer not to answer
Do you suffer from any medical conditions? If so, please provide details
Are you taking any long-term medication? If so, please provide details
Do you wear the following (check all that apply)
- Contacts
- Other
- Glasses
Do you have any children under the age of 18 living at home?*
- Yes
- No

Consent

Email is our primary method of contacting panel members to inform them of study and survey eligibility. If you consent, we will send invitations to participate to the email address you provided. May we email you for this purpose?*
May we call you to invite you to participate in studies at The Media Panel?*

Friend Referral

Were you referred by a friend? Please enter the email address of the person who referred you

I agree that I am not a minor, and that I am at least 18 years of age or older.*

Click to finish and submit your information.