Sign-up form to participate in a research survey for people with visual impairments
We are conducting an online survey only for those who have visual impairment. To participate in the survey you need to have access to a computer or smartphone with a screen reader and Internet connection. For your participation in the survey, you will be enrolled in a random drawing with a chance to win one of ten $20 gift certificates and have a 1 in 10 chance of winning. Please note that to participate in this study, you must identify as visually impaired, be 18 years or older, and live in the United States. If you are visually impaired and willing to take part in this survey, you need to fill the following questions first. Once you provide the details, one researcher will contact you via email or phone and send you the web link to participate in the survey.
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Can you please describe your level of visual impairment? (Required) *
Full Name (Required) *
How old are you? (Required) *
Email Address (Required) *
Phone Number (Optional)
Any comment or question? (Optional)
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