Join our panel and you'll be able to tell us your thoughts on a variety of subjects!
Surveys will be conducted frequently and you'll be asked your opinion on a lot of
different issues. Current events affecting our city, nation news stories, sports
and just about anything you might expect to find in the newspaper.
Survey results will be published in the Journal on a regular basis.
See how your opinions stack up with the rest of the panel!

When you are chosen for a survey, you'll receive an e-mail message. The
surveys are very short and conducted on-line. It's lots of fun and easy.

All responses are completely anonymous. We promise that
your name, information and e-mail address will
never be sold or used for any other purpose.

Plus, each time you complete a survey, you're entered into a drawing to
win a cash prize!

"You're the Source" surveys will be conducted by WiredInsights, an independent national
on-line research company, located in Winston-Salem. As part of our panel,
you'll also be part of the WiredInsights panel and will have the opportunity
to participate in national studies.

Below are some questions that are necessary so we can divide the panel into segments for
occasional specialized studies, such as "Young Adults' Views of Nightlife in Winston-Salem,"
or "Male vs. Female Opinions on the Death Penalty."

To join our panel, completely fill in the questions below and press the
"Submit" button. It's going to be fun!


1. What is your birthdate?
Month Year

2. Are you:

3. What is your marital status?

4. Do you have children in any of the following age groups? (Please select yes or no for each age group.)

Age Range

Yes No
2-5
6-9
10-13
14-17

5. What is your ethnic heritage?

Heritage

Caucasian
African-American
Asian
Hispanic
Other


6. Are you currently a student?

7. Please indicate highest level of education:

8. In what field are you currently employed?
Education
Health Care
Government
Business
Manufacturing
High Tech
Other

9. Do you own your own home?

10. Please indicate three to five of your interests/hobbies.
Spectator Sports
Participatory Sports
Do-It-Yourself Projects
Travel
Photography
Gardening
Reading
Hunting or Fishing
Camping
Home Decorating
Cooking
Exercise/Physical Fitness
Computers
Movies

11. What is your annual household income?

12. How many people - including both children and adults -
in the household would enjoy participating in our surveys?

13. Where do you primarily use your computer?

And how often do you use your computer for internet access?

14. So that we can notify you about our surveys and for general geographic purposes, please give your zip code and e-mail address.

Zip code

E-mail address

15. How did you find out about our panel?


The following requests for name, address and telephone
number are
required so that we may be able to contact 
you in the event you
win a prize.

What is your first name?

What is your last name?

Street Address or P.O. Box?

City?

and State?

Daytime telephone number?



Please provide a password so that you will be able to modify
your information in the future. (It must be at least four characters.)

... and re-enter it.

If you have any questions or problems, please e-mail us at info@wiredinsights.com.