Please complete the eligibility form below. After you have filled out each of the required fields, select the submit button at the bottom of the form. After submitting the form, we will contact you for a brief 5-10 minutes phone interview. Thank you for your interest and I look forward to speaking with you. If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required First Name * Last Name * Email * Phone Number * 1. Age * 2. Sex * Female Male 3. Race or Ethnicity * Asian/Pacific Islander Black American Caucasian Hispanic Native American Other 4. Marital Status * Divorced Living with Significant Other Married Seperated Single Windowed 5. Number of Children * 6. Ages and Genders of Children * 7. What is your present job or occupation? * 8. List former occupations * 9. What is the extent of your formal education? * 10. Do you have any specialized training or experience in other fields? 11. Have you ever served jury duty before? * Yes No If yes, what was the subject matter of the case or cases? 12. What do the adults in your household do for a living? 13. Have you or anyone you know ever been involved in a law suit, as either a defendant, a plaintiff or a witness? * Yes No If yes, please describe your role, the type of suit, and the outcome. 14. Have you or anyone close to you ever been in a bad car accident? * Yes No If yes, please describe. 15. Do you or anyone close to you have any specialized training in biomechanics, medicine, pain management, rheumatology etc? * Yes No If yes, please describe. 16. Do you or anyone you know, work for an insurance company, a law firm, law enforcement, an accident reconstruction expert, a toxicologist, or any other occupation that works with auto accidents or with determination of fault in automobile accidents? * Yes No If yes, please describe. 17. Have you ever participated in a mock jury/focus group before? * Yes No If yes, what was the subject matter? 18. Have you ever been convicted of a felony? * Yes No If yes, please describe. 19. Do you or anyone close to you have sensitivities, experience, or strong feelings about any of the following subjects? (Check all fields that apply) * Personal InjuryRapeMurderChild Abuse or NeglectDriving Under the Influence of AlcoholGangsViolent CrimesCar AccidentsBack InjuriesSexual HarassmentMolestLaw EnforcementNone If yes, please describe.