3M Combat Earplug Lawsuit Questionnaire

Have you served in the US Military between 2003 and 2015?
Yes
No
If Yes, which years?
If Yes, which branch of the Military did you serve in?
Airforce
Army
Coast Guard
Marines
Navy
Other
Did you serve in a combat zone between the years 2003 and 2015?
Yes
No
If Yes, please select from the following regions
Iraq
Afghanistan
Other
Did you use 3M's Dual Ended Combat Arms earplugs during military service?
Yes
No
Have you been diagnosed by a medical professional with hearing loss or tinnitus?
Yes
No
Full Name
Telephone Number
Address
Time Zone
Eastern Standard time
Central Standard Time
Mountain Standard Time
Pacific Standard Time
Alaska Standard Time
Email Address
Preferred Contact Method
Phone
Email
Mail
What is the best time to reach you?
Morning 9 am to 12 pm
Afternoon 12 pm to 5 pm
Evening 5 m to 8 pm
{"name":"3M Combat Earplug Lawsuit Questionnaire", "url":"https://www.quiz-maker.com/QKKJ129","txt":"Have you served in the US Military between 2003 and 2015?, If Yes, which years?, If Yes, which branch of the Military did you serve in?","img":"https://cdn.poll-maker.com/37-1254104/questionnaire-cover-page.jpg?sz=1200-00000010001000005300"}
Quiz Maker Logo Make your own Quiz
Powered by: Quiz Maker