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!