FT WORTH MOM’S STUDY

DATE: Thursday, August 5, 2010
TIME: Early Afternoon
LOCATION: Downtown Ft Worth
PAYS: $100/90 Minutes

REQUIREMENTS:
Females, Ages 25 to 50
You are pregnant with your 1st Child
You have private insurance
Tarrant County Residents ONLY

Enclose the information below with your answers to the right of each item. Address your email to BOTH mail@marketresearchdallas.com AND info@sunshineday.net. Be sure Ft Worth Mom’s Study is in the subject line when responding. Please delete all the information above including this paragraph. Extra info means extra paper & extra ink!

First & Last Name
Street Address
City, TX, Zipcode
Referred by Melinda aka SunshineDay
PHONE NUMBERS PLEASE!
Home #
Work #
Cell #
Email Address
Age & Birthdate
Ethnic Background
Marital Status
Employment Status
Household Income
Last Level of Education Completed
Are you currently pregnant with your first child?
How many months along are you?
Who is your insurance provider?
What hospital do you plan on using to deliver your baby?
Is there any hospital you would NOT consider?
Did you address your email to BOTH mail@marketresearchdallas.com AND info@sunshineday.net?
Do you have Ft Worth Mom’s Study in the subject line?
Did you enclose ONLY the questions asked with your answer to the right of each item?