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Twin Research Registry Logo

Adult Online Registration

 

Are you a TWIN? You may be eligible to participate in research to help scientists advance new treatments for diseases and explain the roles of genetics and the environment in health and behavior.

This registration form is for adults only (18+ years old). Parents of twins aged 17 and under may register their children by calling 1-800-SRI-TWIN (1-800-774-8946).

You will receive regular updates from SRI International's Center for Health Sciences describing opportunities to participate in health research, but you are under no obligation to enroll in these studies.

To register over the phone, call 1-800-SRI-TWIN (1-800-774-8946).

The information you provide will remain confidential.

Please indicate your gender and your twin's gender by clicking the responses below:

My gender:

Male
Female
Other 		 

My twin's gender:

Male
Female
Other

1. As far as you know, are you and your twin:

Fraternal
Identical

2. During your entire life, how close do you feel that you and your twin have been compared with your impression of closeness between ordinary siblings?

Less close than ordinary siblings
As close as ordinary siblings
Somewhat closer than ordinary siblings
Much closer than ordinary siblings

3. How far in miles do you live from your twin now?

4. How frequently do you and your twin get together now?

Almost daily
1-4 times per week
1-3 times per month
Occasionally during the year
Less than once per year

5. Please give us your name, address, telephone number, and email address:

First Name:
Last Name:
Number and Street:
City, State, Zip
Telephone:
Email Address:

6. Please provide your twin's name, current address, telephone number, and email address:

First Name:
Last Name:
Number and Street:
City, State, Zip
Telephone:
Email Address:

7. May we contact your twin concerning joining this registry?

No
Yes

8. What is your date of birth?

Month Day Year

9. What is your ethnic group?

Black, non-Hispanic
White, non-Hispanic
Hispanic
Asian
Other

10. What is your marital status?

Single
Married
Living together, not married
Divorced
Widowed

11. How many years of higher education have you completed?

12. Do you currently smoke cigarettes?

No
Yes

Number smoked per day:
Age you started smoking:

13. Are you a former smoker?

No, I have never smoked
Yes

Number smoked per day:
Age you started smoking:
Age you quit smoking:

14. Where did you see/hear about SRI's twin registry (click on all that apply):

Online (specify: search engine, online radio, other):
SRI web site
Newspaper (specify):
Radio (which station?)
Posters
Other (specify):

Check here if you wish to participate in current research studies.

THANK YOU for completing the SRI Northern California Twin Registry registration form. You will receive your membership confirmation soon!

By clicking the 'submit' button below, you voluntarily consent to register with the SRI Northern California Twin Registry. By registering, you become eligible to participate in future twin research studies. You agree that you may be contacted by researchers about the possibility of participating in studies, but you will be under no obligation to participate in any study. All information gathered from this registration form will be held in confidence. You can remove your name from the registry at any time by contacting us at 1-800-SRI-TWIN (1-800-774-8946), or by post at SRI International, 333 Ravenswood Avenue, Menlo Park, California 94025, or via e-mail at: sri.twin@sri.com.

 
Please type the two words you see above:  

 

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