Participant Online Registration Form

Participant Registration Information

This information is for those wishing to be registered for consideration as a research subject in the future. Both non-gamers and gamers are desired. This information is kept confidential.

First Name  

Middle Name(s)

Last Name  

Preferred Phone

Alternate Phone

City  

State / Province

Where applicable.

Country

Zip / Postal Code

Year of Birth  

RPG Previous Participation ■

Have you ever participated in any of the following activities. Please note that if you have never participated in any of the activities, please select "None". This research project does need participants who have never participated in these activities before, as well as those who have engaged in these activities previously.

None (Never participated in role-playing games)

RPG (Role-playing Gaming - classic paper and dice)

CRPG (Computer-based Role-playing Games, single-player offline)

PBM/PBEM (Play by Mail / Play by E-mail)

MUD/MUSH (Multi-User Dungeon / Multi-User Share Hallucination)

ORPG/MMORPG (Online RPG / Massive Multi-player Online RPG)

LARP (Live Action Role-player)

Wargaming (board/miniature)

Gender ■

Female
Male
Other

RPG Research Participation? ■

Do you think you may be able to participate in the research sessions at the facilities in Spokane, Washington? The address is 1312 N. Monroe, Spokane, WA, 99201. (509) 252-0800. If you can not make it to the Spokane facilities, would you be able to participate online by completing online questionnaires?

Yes, I can participate in person
No, but I can only participate online
No, I can not participate in person or online.

Questionnaire

This information is confidential. It will only be used for demographics analysis.

Psychology research participation?

Have you ever participated in a psychological / therapeutic research study before?

Yes
No

Previous research experience

Have you ever participated in any kind of research study before?

Yes
No

Recreation therapy experience?

Have you ever participated in recreational activities under the guidance of a therapist?

Yes
No

Birth state/province

What state/province were you born in?

Marital status

Single
Married
Divorced
Widowed
Other

Children

Yes
No

Number of children

Employment Status

Full-time Employment
Part-time Employment
Self-employed
Retired
Unemployed
Disabled
Other

Occupation(s)

Income

Combined annual gross income range?

Unspecified <20,000/yr 20k-59k 60k-99k 100k-149k 150k-249k 250k-499k 500k-999k 1M-2M 3M-4M 5M-9M 10M-19M 20M+

Residential status?

Own
Rent
Live with parents/family
Homeless
Other