SRI International's Northern California Twin Registry


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Adult Online Registation

SRI's Center for Health Sciences seeks identical and fraternal twins 18 years or older who live in the San Franciscso Bay Area to join the Northern California Twin Registry. Parents of twins aged 17 and under are asked to call 1-800-SRI-TWIN (1-800-774-8946) to register their twins.

By submitting the following form you will become eligible (but under no obligation) to receive regular updates describing opportunities to participate in health research. If you have a twin brother or sister, please fill in the following or make a selection where appropriate.

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

The information you provide will remain strictly confidential, known only to staff of the SRI Northern California Twin Registry.

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

My gender:
Male
Female

My twin's gender:
Male
Female

1. As children, were you and your twin:

"As alike as two peas in a pod"
Of only ordinary family resemblance

2. In childhood, did your parents, brothers and sisters, or teachers have trouble telling you apart?

No
Yes

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

Fraternal
Identical
Don't know

4. 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

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

6. 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

7. If this was not sent to your permanent address, please give us your name, address, telephone number, and email address (if applicable):

Name:
Number and Street:
City, State, Zip
Telephone: (Day and Evening):
Email Address:

8. Please give your twin's name, current address, telephone number, and email address (if applicable):

Name:
Number and Street:
City, State, Zip
Telephone: (Day and Evening):
Email Address:

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

No
Yes

10. What is your date of birth?

Month Day Year

11. What is your ethnic group?

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

12. What is your marital status? (please click on only one)

Single, never married
First marriage
Second or later marriage
Living together, not married
Divorced
Widowed
Separated

13. What is the highest level of formal education you have completed? (please click on only one)

Less than 8th grade
8th grade
High school or GED
Technical or professional training
Associate's degree
Bachelor's degree
Master's degree
Doctorate

14. Do you currently smoke cigarettes?

No
Yes, number smoked per day:
Age you started smoking:

15. Are you a former smoker?

No, I have never smoked cigarettes.
Yes, number smoked per day:
Age you started smoking:
Age you quit smoking:

16. Where did you see SRI's twin advertisements (click on all that apply):

Newspaper (specify):

Movie theatre

Radio

Other (specify):

Click on "Submit" below to send your information. THANK YOU for completing the Northern California Twin Registry registration form. Your responses will be held in strictest confidence. We will send you a membership card soon!

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