i-Respondent.com

>>> Members : Please login to complete other available sections or update your records regularly to make it current. You may now upload your current photo in your account. Thank you! <<<

Friday, 24 May 2013

Under 18 Registration Form

By completing this form, you are consenting to volunteer yourself to participate in any surveys coordinated by i-Respondent Sdn Bhd. When your information matches current research study criteria, we may contact you to enquire about your interest and availability in participation.

Please complete the entire form honestly to ensure integrity of database for quality survey.

If you qualify for a study and choose to participate, we will reward you for your time and commitment. Incentive payouts are determined by the sponsors of each study.

LOGIN DETAILS
Username	* Please do not use spacing
Desired Password
Re-type Password

PERSONAL PROFILE

Salutation

Full Name as in NRIC / Passport

Given Name

NRIC No. (New) / Passport No.

* Alpha-numeric only (NRIC/Passport No. is Optional)

Nationality

Race

If others, please specify

Date of Birth

Address Line 1

Address Line 2

Postcode

State

Country of Residence

Contact No. (H)

* +603-12345678

Contact No. (M)

* +6016-12345678

Email Address

Alternative Email Address

Gender

Male Female

Religion

If others (please specify)

Student of (Name of School)

Highest Education

Stream

If others, please specify

Father's Name

Father's Contact No. (O)

* +603-12345678

Father's Contact No. (M)

* +6016-12345678

Mother's Name

Mother's Contact No. (O)

* +603-12345678

Mother's Contact No. (M)

* +6016-12345678

Legal Guardian's Name

Legal Guardian's Contact No. (O)

* +603-12345678

Legal Guardian's Contact No. (M)

* +6016-12345678

How did you know about our services?

If others, please specify

I hereby confirm that all particulars and information given are true and correct. I authorise i-Respondent Sdn Bhd to use my data for market research purposes. I agree that if the information on my personal particulars is, in any part, false or incorrect, i-Respondent Sdn Bhd reserves the rights to terminate my membership instantly.

UNDER 13 REGISTRATION OBLIGATIONS

i-Respondent Sdn Bhd is concerned about the safety and privacy of all its users, particularly children. For this reason, upon receipt of the Under 18 Registration Form (the "Registration Data") of children under the age of 13, i-Respondent Sdn Bhd shall obtain a verbal or written permission from parents/legal guardians of children who wish to allow their children access to i-Respondent.com.

Thus, you also give your child permission to access many areas of i-Respondent.com, including email, newsletters, message boards, banners, hyperlinks to other websites and instant messaging (among others). Please remember that i-Respondent.com is designed to appeal to a broad audience. Accordingly, as the parent/legal guardian, it is your responsibility to determine whether any of the areas, sections and/or content is appropriate for your child.

Thank you for your registration and interest!