New York Times Brain Imaging Study

First Name

Last Name

E-mail Address

Age

Date of Birth

Gender

Ethnic Origin

Occupation of Head Of Household

Your Occupation

Address

Post Code

Contact Number

Are you a permanent resident in the UK and been living in the UK for the last year?

Yes, I am a permanent UK resident and have lived in the UK for the last yearNo, I am not a permanent UK residentI am a UK resident but I have not lived in the UK for at least one year

Have you taken part in a Brain Imaging Study in the past?

YesNoNot sure

Have you been contacted by another Market Research Recruiter to take part in this or any other Brain Imaging Study recently?

YesNoNot sure

Do you suffer from...

EpilepsyMigrainesNeither

How often do you suffer from migraines?

Once or twice a weekOnce a monthLess than once a monthNever

What triggers your migraines?

Do you suffer from severe sensitivity to light?

YesNo

Have you had any Brain Surgery or had any type of Brain Injury in the past?

YesNo

This study requires access to your scalp - do you wear wigs, hairpiece or any other head coverings or anything that will make access to your scalp difficult?

YesNo

Do you or any members of your household currently work, or have worked in the last year, in any of the following industries/occupations?

Advertising agency or advertising department within a companyMedia/Journalism/PublishingMarket ResearchMarketingNewspaper (either in Print or Digital)Public RelationsNone of the above

What is your Marital Status?

SingleMarriedCo-habitingWidowedDivorcedSeparated

What is your working status?

Full timePart timeStudentNonRetired

Into which of these brackets does your personal income fall?

Under £25,000£25,000 - £50,000£50,001 - £70,000£70,001 - £100,000Over £100,000

What figure describes your household net worth (the value of your possessions and investments but excluding the house you live in)?

Under £100,000£100,000 – 249,999£250,000 - £499,999Over £500,000

Which of the following ONLINE publishers do you use to read the news nowadays (either on a website or App)?
Please list all that apply.

At least once a week

The Guardian*The TelegraphFinancial Times*Economist*New York Times*New ScientistWall Street Journal*CNN World News*BBC World*

Less often than once a week

The Guardian*The TelegraphFinancial Times*Economist*New York Times*New ScientistWall Street Journal*CNN World News*BBC World*

Never

The Guardian*The TelegraphFinancial Times*Economist*New York Times*New ScientistWall Street Journal*CNN World News*BBC World*

And are there any of these publishers that you would avoid when looking at news sources?

The Guardian*The TelegraphFinancial Times*Economist*New York Times*New ScientistWall Street Journal*CNN World News*BBC World*

What time of day you usually read your daily newspaper on weekdays?

Before 9amBetween 9am and lunchtimeAt lunchtimeBetween lunchtime and 6.00pmEvening (6.00pm onwards)

What time of day you usually read your daily newspaper on weekends?

Before 9amBetween 9am and lunchtimeAt lunchtimeBetween lunchtime and 6.00pmEvening (6.00pm onwards)

Which of the following social media platforms do you use?

Often

Facebook*TwitterSnapChatInstagram*n/a

Sometimes

Facebook*TwitterSnapChatInstagram*n/a

I don’t use this platform at all

Facebook*TwitterSnapChatInstagram*n/a

Are you happy with the information you’ve just given to me to be shared with Emerald Fieldwork and Neuro Insight? (Emerald Fieldwork are co-ordinating the whole recruitment process and Neuro Insight is the company who is carrying out the research)?

YES I AM HAPPY FOR THE INFORMATION TO BE SHAREDI AM NOT HAPPY FOR THE INFORMATION TO BE SHARED

Which group are you interested in attending?

GROUP 11: Saturday 8th December - 11.00amGROUP 12: Saturday 8th December - 2.00pmGROUP 13: Saturday 8th December - 4.30pmGROUP 14: Saturday 8th December - 6.00pmGROUP 16: Monday 10th December - 7.30pm