Please verify your information – Medford and Bend

Please take a moment and submit your responses to the questions to verify we have everything correct about you for your upcoming research study!

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Please enter the email you have with us.
What is the best number to contact you at via phone?
Enter the year you were born, like 1999 or 1972.
Please enter a number from 1900 to 2050.
Which best describes the gender to which you most identify?
Which US County, Parish, or Township do you live in?
What is your race or ethnicity? If you are mixed race, select all races you represent.
Which best describes the highest level of education you have had the opportunity to complete?
Do you work in, or have any training in any of the following industries or fields? Select all that apply.
Children at Home*
Do you have any children under the age of 18 at home?
Which best represents your current marital status?
Which category best represents your family's total household income, before taxes annually?
Which best describes your current employment status?
Home Ownership*
Fire Experience*
Have you or has anyone in your immediate family experienced injury or property loss due to a wildfire?
Fire Impact*
Have you been impacted by any of the following: the Beachie Creek, Kimberling, Echo Mountain, 242, Obenchain, Archie Creek or Slater Fires?
Please enter your mailing address so we can mail you your study information in addition to the email information you will receive from us. Include your CITY, STATE, and ZIP CODE as well.
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