Nicotine Study #4560 Question Title * 1. Contact Information: First Name Last Name Phone Number Email Address Home Address City State Zip Code Question Title * 2. What is your age? Question Title * 3. What is your DOB? Date Date Question Title * 4. What is your gender? Female Male Other (please specify) Question Title * 5. Which of the following best describes your ethnicity? Asian or Asian American Black or African American Native Hawaiian or other Pacific Islander Hispanic or Latino Middle Eastern American Indian or Alaska Native White or Caucasian Other (please specify) Question Title * 6. If you are selected to participate in this study, the session will be recorded for research purposes only. This information will not be shared publicly, and will solely be used for the purposes of this project.Do you feel comfortable being recorded? Yes No Next
