Participant Form Portland, OR - Focus Group Enrollment Register with us by filling out the form below.RM_StatsFirst Name *Last Name *Age *Gender Male Female Phone *Secondary PhoneEmail * City, State State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Annual Household Income * Less Than $15k/yr $15k - $50k /yr $50k - $75k /yr $75k - $125k /yr $125k or higher /yr Do You Rent or Own Your Home? *Select an optionRentOwnHave you considered an independent/senior living or active adult community in the last 12 months?Select an optionYesNo Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
