Product Advisory Group

Name *

First Name

Last Name

Phone

(###)

###

####

Age *

Under 18

18 - 25

26 - 39

40 - 59

60+

Gender *

Male

Female

Non-Binary

Prefer not to say

Marital Status *

This is how you present yourself to the world not a legal status

Single

Married

Divorced

Separated

Widowed

Education *

Highest Level Attended or Graduated from

Highschool

Trade school

2 Year Degree

4 Year Degree

Masters Degree

Doctorate

Employment Status *

Choose the status you typically are

Employee Full-time

Employee Part-time

Self-Employed

Business Owner

Unemployed

Disability

Retired

Tech Adoption Rate *

How quickly to you adopt new tech

Fast (as soon as I hear about a new thing)

Average

Slower (Only if I must)

Never (I HATE technology)