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We realize there is a lot of information on this form. Not everything is
required, but the more you supply, the more we will benefit. We value your
privacy. For more information, please see our privacy policy.
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First Name *
Last Name *
Street Address
City
Country
State/Province
Zip/Postal Code
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E-mail Address *
Daytime Phone *
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Evening Phone *
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International Phone (Required if outside U.S./Canada)
Indicate the highest education level completed:
If English is not your first language, please select your native
language.
How did you find out about this site? *
* Required fields
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Gender *
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Handed
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Date of birth: *
Note: You must be 17 years or older before your information will be
activated.
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Indicate your yearly household income:
What is your marital status?
How many children under the age of 18 reside in your household?
Check the statements below that best describe you:
How much do you spend on technology per year?
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Check any of the following you have in your home:
If you are a DVR user, please indicate what type below:
What type of mouse is used on your home computer?
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What type of keyboard is used on your home
computer?
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How do you receive your TV programming?
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Name of your organization or employer:
Your organization's product or industry:
How many employees are in your organization?
How many employees report directly to you?
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Current job title or position: *
Briefly, describe your job responsibilities:
* Required field
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Check the statements below that describes
your role(s) at work. (check all that apply)
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What computer/operating systems do you
use? (check all that apply)
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How often do you use computers?
Check the statements below that best describe you. (check all that
apply)
Check the topics, or activities, you research on the Internet. (check
all that apply)
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What Internet Browser do you use?
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What E-mail application do you use?
How do you connect to the Internet? (check all that apply)
How long have you been using computers?
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Please list the software applications you
use most frequently and your experience level.
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In the section below please indicate any programming
languages, development tools, network environments and/or databases
that you administer.
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Language or Tool:
Language or Tool:
Language or Tool:
Language or Tool:
Language or Tool:
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Network or Database:
Network or Database:
Network or Database:
Network or Database:
Network or Database:
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From the list below, select the mobile
device(s) you currently own or use.
Select the brand of your mobile device below:
What is the model name or number of the above mobile device?
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