Census Web Site Usability Testing Research

STATEMENT OF RELEASE

Thank you for agreeing to participate in this study. Your privacy and the privacy
of your answers will be respected and maintained. Your personal information will
not be disclosed and your individual answers will only be presented at an
aggregate level. You will not be sold anything, or asked for money, under the
guise of research. Your decision to participate in a study, answer specific
questions, or discontinue your participation will be respected without a question.
Each interview will be recorded and may be observed.
You acknowledge and agree that you have read this Statement of Release and
fully understand its contents. You release and hold harmless Media &
Entertainment Strategies, Inc. and the US Census and its employee(s), officers,
owners and directors from any and all injury and damages, which may arise
directly or indirectly, from your participation in this study.

Name of Participant: _________________________________ Age: ______
Signature of Participant: ______________________________
Date: _______________
Address: _____________________________
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