Form 1e Survey

LIFE
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System Date:

Mode: Production

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Male Questionnaire (OHM)
Version: 1.02; 01-19 -06

OMB# 0925-0543
Exp. 06/30/2010
Public reporting burden for this collection of information is estimated to average 25 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch,
6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0543).
Thank you for agreeing to participate in the LIFE Study. As you know, this important study focuses on the effects of lifestyle and the
environment on reproductive health. Your participation is voluntary and you are free to withdraw from the study at any time for
whatever reason. We do, however, hope that you will want to continue to participate. As a reminder, all information that you provide
will be kept strictly confidential and used for medical research purposes only. It is our duty to ensure your privacy.
I am first going to ask you some questions about your occupation and then I will ask some questions about your medical
history, and finally about your lifestyle.

Occupational History
1.

Are you currently employed? This includes part-time
and full-time jobs, jobs at home, on a farm, or outside
your home that are paid or military service.
Interviewer, read if necessary: Students,
homemakers/parents, temporarily unemployed and the
disabled are not considered "currently employed".

0-No

1-Yes

Does your current job involve any of the following:
a.

Night work:
Interviewer, read if necessary: Work schedule in
which most hours (>50%) are in the evening
(between 4pm and midnight) or at night (between
midnight and 8am).

0-No

1-Yes

b.

Rotating shifts:
Interviewer, read if necessary: Work schedule in
which the work time changes between days,
evenings and/or nights.

0-No

1-Yes

c.

Whole body vibration:
Interviewer, read if necessary: Vibration
associated with driving a car, truck, bus, van, fork lift,
earth moving equipment, tractor, train, helicopter,
etc.

0-No

1-Yes

d.

Noise:
Interviewer, read if necessary: Loud or very loud
noise experienced in the work environment while
performing job (for example: lawn equipment, large

0-No

1-Yes

earth-moving equipment, jack hammer work, airport
field area, rock concert stage) or (if you have to
shout to be heard by a person 3 feet away from you)
generally >85 decibels.
e.

Extreme heat:
Interviewer, read if necessary: A work
environment that is warmer than 100o F. Examples
include kitchen jobs, jobs in the dry cleaning
industry, and summer construction work.

0-No

1-Yes

f.

Heavy exertion or lifting:
Interviewer, read if necessary: Exerting in excess
of 50 pounds of force occasionally, and/or in excess
of 25 pounds of force frequently, and/or in excess of
10 pounds of force constantly to move objects.
Force may involve lifting, carrying, pushing, or
pulling.

0-No

1-Yes

g.

Prolonged sitting:
Interviewer, read if necessary: Primary work
position is sedentary with the total number of hours
working in a sedentary position during a day greater
than 6 hours.

0-No

1-Yes

LIFE
$sitecode

User:

System Date:

Mode: Production

Site Name:

Male Medical History A (MMA)
Version: 1.02; 08-15 -06

The next few questions ask about your overall medical history.

1. Have you ever been told by a doctor that you have any of the following health conditions:

a.

Hypothyroid disease (under -active thyroid) :

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

Pills:

0-No

1-Yes

Insulin:

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

Are you currently receiving medical treatment for
this condition?

b.

Hyperthyroid disease (over-active thyroid):
Are you currently receiving medical treatment for
this condition?

c.

High blood pressure:
Are you currently receiving medical treatment for
this condition?

d.

High cholesterol:
Are you currently receiving medical treatment for
this condition?

e.

Diabetes (also known as 'sugar'):
Are you currently receiving medical treatment for
this condition?

Does the treatment include:
Diet:

f.

Urethritis (infection of the urethra):
Are you currently receiving medical treatment for
this condition?

g.

Mumps after age 18 years:

h.

i.

Anxiety disorder:
Interviewer, read if necessary: Anxiety Disorders are
defined as a group of disorders characterized by
persistent anxiety that is severe enough to interfere
with a person's daily activities.
Do you have:
Agoraphobia:
Interviewer, read if necessary: Anxiety about
being in places or situations from which escape
might be difficult (or embarrassing) or in which
help may not be available.
Obsessive-compulsive disorder (OCD):
Interviewer, read if necessary: ObsessiveCompulsive Disorder is characterized by
uncontrollable obsessions and compulsions which
the sufferer usually recognizes as being excessive
or unreasonable. Obsessions are recurring
thoughts or impulses that are intrusive or
inappropriate and cause the sufferer anxiety.
Panic disorder:
Interviewer, read if necessary: Panic Disorder is
defined as condition in which individuals
experience recurrent panic attacks. Panic attacks
are characterized by the abrupt onset of an
episode of intense fear or discomfort.
Post traumatic stress disorder (PTSD):
Interviewer, read if necessary: Posttraumatic
Stress Disorder is a disorder that can occur
following the experience or witnessing of lifethreatening events such as military combat,
natural disasters, terrorist incidents, serious
accidents, or violent personal assaults like rape.
People who suffer from PTSD often relive the
experience through nightmares and flashbacks,
have difficulty sleeping, and feel detached or
estranged.
Social anxiety disorder:
Interviewer, read if necessary: Social Anxiety
Disorder is characterized by an intense fear of
situations, usually social or performance
situations, where embarrassment may occur.
Generalized anxiety disorder:
Interviewer, read if necessary: Generalized
anxiety disorder is characterized by a pattern of
frequent, persistent worry and anxiety for six
months or more, about several different events or
activities.
Are you currently receiving medical treatment for
any of these conditions?

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

Mood disorder:
Interviewer, read if necessary: Mood Disorders are
defined as a group of disorders characterized by a
disturbance in one's emotional state.
Do you have:
Major depression:
Interviewer, read if necessary: Major depression
is defined as a period of at least two weeks during
which a person loses pleasure in nearly all
activities and/or exhibits a depressed mood.
Bipolar disorder:
Interviewer, read if necessary: Bipolar Disorder
is characterized by the occurrence of one or more
major depressive episodes accompanied by at
least one manic episode.

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

Other:
Are you currently receiving medical treatment for
any of these conditions?

0-No

1-Yes

0-No

1-Yes

2. Have you ever been told by a doctor that you have any of the following conditions?

a.

b.

c.

Undescended testicles or cryptorchidism:

0-No

1-Yes

Have you ever received surgical treatment for this
condition?
What year did you receive surgical treatment?

0-No

1-Yes

Hypospadias or misplaced opening of urethra on
head of penis:
Have you ever received surgical treatment for this
condition?
What year did you receive surgical treatment?

0-No

1-Yes

0-No

1-Yes

Varicocele or varicose veins of the scrotum (dilated
veins on the scrotum or penis):
Have you ever received surgical treatment for this
condition?
What year did you receive surgical treatment?

0-No

1-Yes

0-No

1-Yes

(yyyy)

(yyyy)

(yyyy)

LIFE
$sitecode

User:

System Date:

Mode: Production

Site Name:

Male Medical History B (MMB)
Version: 2.00; 01-19 -06

1.

Have you ever been diagnosed with cancer?
a.

0-No

1-Yes

With how many types of cancer have you been
diagnosed?

Now I am going to ask you about each cancer diagnosis, starting with the last one with which you were diagnosed.
Cancer Number

With what type of cancer were you diagnosed?

In what year were you diagnosed?

1

(yyyy)

2

(yyyy)

3

(yyyy)

2.

In the past 3 months, have you had a fever greater
than 100° F?

0-No

1-Yes

3.

Are you currently taking any prescription medications,
including prescription vitamins?
a.
How many prescription medications?

0-No

1-Yes

May I please see your prescription medication bottles so that I can record the names of the medications that you are taking?
Prescription Medication

Prescription Bottle Available
for Confirmation

1

0-No

1-Yes

2

0-No

1-Yes

3

0-No

1-Yes

4

0-No

1-Yes

5

0-No

1-Yes

6

0-No

1-Yes

7

0-No

1-Yes

8

9

0-No

1-Yes

0-No

1-Yes

Interviewer: Advise the man that he may want to discuss his current medication use with his doctor in relation to his partner/spouse
becoming pregnant.

4.

In the past 3 months, did you take a multivitamin such
as a One-a-Day, Theragran -M, or Centrum (as pills,
liquids, or packets) more than once a week?

0-No

1-Yes

5. In the past 3 months, did you take any of the following supplements more than once a week?
Interviewer: Hand show card to participant.

a.

Fish oil (omega-3 fatty acids):

0-No

1-Yes

b.

Echinacea:

0-No

1-Yes

c.

Ginko biloba:

0-No

1-Yes

d.

Kava, Kava:

0-No

1-Yes

e.

St. John's Wort:

0-No

1-Yes

f.

Protein shakes:

0-No

1-Yes

g.

Steroids:

0-No

1-Yes

h.

Creatine:

0-No

1-Yes

i.

Other supplements:

0-No

1-Yes

What supplement are you taking?
Note to Interviewer: Up to seven other
supplements may be entered as needed.

Now I'd like to ask you a few questions about your body shape and weight over the years.

6.

What is your current age?
a. Which of the body shapes (1 through 9) on this card do you feel most resembles your body shape when you were:
Interviewer: Hand show card to participant.

Copyrighted images are reproduced with permission of Dr. AJ Stunkard from Stunkard AJ, Sorenson T, Schulsinger F. Use of the

Danish Adoption Register for the study of obesity and thinness. In: SS Kety, LP Rowland, RL Sidman, SW Matthysse (Eds.) The
Genetics of Neurological and Psychiatric Disorders. New York: Raven Press, 1983, pp. 115-120.

Age

Shape Number

15 to 19 years old:
20 to 24 years old:
25 to 29 years old:
30 to 34 years old:
35 to 39 years old:
40 to 44 years old:
45 to 49 years old:
50 to 54 years old:
55 to 59 years old:
60 to 70 years old:

b. What was your average weight when you were:

Age
15 to 19 years old:
20 to 24 years old:
25 to 29 years old:
30 to 34 years old:
35 to 39 years old:
40 to 44 years old:
45 to 49 years old:
50 to 54 years old:
55 to 59 years old:
60 to 70 years old:

Weight
(lbs)
(lbs)
(lbs)
(lbs)
(lbs)
(lbs)
(lbs)
(lbs)
(lbs)
(lbs)

7.

What is the most you weighed in the past 12 months?

8.

What is the least you weighed in the past 12 months?

(lbs)

(lbs)

LIFE
$sitecode

User:

System Date:

Mode: Production

Site Name:

Male Reproductive History (RM2)
Version: 1.01; 01-19 -06

The next few questions ask about your reproductive history.

1.

Thinking back to adolescence, did you begin puberty
earlier, later or at about the same time as other boys your
age? By puberty, I mean when you started having beard
growth, voice changes, pubic hair, and ejaculation.

1-Earlier than other boys your age
2-About the same as other boys your age
3-Later than other boys your age

2.

Have you ever fathered a pregnancy, regardless of
outcome?
a.
How many pregnancies have you fathered?

0-No

1-Yes
(pregnancies)

LIFE
$sitecode

User:

System Date:

Mode: Production

Site Name:

Male Pregnancy (RHM)
Version: 1.01; 01-19 -06
Pregnancy Number:

1.

How old were you when you fathered this pregnancy?

2.

Was this a planned pregnancy:
a.

3.
a.

0-No

How many months did it take for your partner to
achieve pregnancy:
Was this a multiple pregnancy?
How many fetuses were there?

What was the outcome
of this pregnancy?
1-Live Birth
2-Miscarriage
3-Stillbirth
4-Abortion
5-Ectopic/tubal
6-Molar pregnancy
Fetus A
Fetus B
Fetus C
Fetus D
Fetus E

Comments:

(yrs)
1-Yes

0-No, singleton pregnancy
(fetuses)

Date of Birth or Loss
(mm/dd/yyyy)

1-Yes, multiple pregnancy

LIFE
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User:

System Date:

Mode: Production

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Male Family Health History (FHM)
Version: 1.00; 01-19 -06

The next few questions relate to when you were born. Please answer these questions to the best of your knowledge.

1.

How much did you weigh when you were born?

2.

When you were born, were you:

(lbs)

(oz)

1-Premature-more than 3 weeks early (<37 weeks gestation)
2-Postterm-more than 2 weeks late (>42 weeks gestation)
3-Full term (37-42 weeks gestation)

3.

Were you a twin or a triplet?
1-No, singleton
2-Yes, twin, triplet, or higher order

LIFE
$sitecode

User:

System Date:

Mode: Production

Site Name:

Male Lifestyle Factors (LFM)
Version: 2.00; 09-07 -07

The next set of questions are about your lifestyle. Please give me your best answer, even if you are not entirely sure
about your answer.

1.

During the past 12 months, have you followed a
regular vigorous exercise program? By vigorous
exercise, I mean a leisure time physical activity that
made you sweat and your heart beat faster, such as
tennis, running, bicycling, aerobics, basketball,
swimming, or brisk walking.
Interviewer: Regular is defined as at least once a week
over the past 12 months.
a.

2.

1-Yes

How many days on average do you exercise per
week?

During the past 12 months, have you taken a hot
bath, sauna, Jacuzzi, or a hot tub for more than 10
minutes at a time?
a.

0-No

0-No

1-Yes

Specify average number of times per month:

3.

Do you or a member of your household catch fish or
shellfish in local waters including lakes, rivers, streams,
and the Great Lakes?
4.
Do you or a member of your household catch fish or
shellfish in local waters including lakes, rivers, bays, ship
channels, local ocean waters and the Gulf of Mexico?

0-No

1-Yes

0-No

1-Yes

5. On average, during the past 12 months, how often did you eat each of the following fish or shellfish? As I read each category,
please tell me whether you ate the fish or shellfish:
Never or almost never, Less than once a month, About once or twice a month, About once a week, Two or more times a
week.
a.

Canned tuna fish:
0-Never or almost never
1-Less than once a month
2-About once or twice a month
3-About once a week
4-Two or more times a week

b.

Fish caught in an unknown location (other than
canned tuna fish) that was given to you or purchased
from a vendor, grocery store or restaurant. Please
include both fresh and frozen fish.

0-Never or almost never
1-Less than once a month
2-About once or twice a month
3-About once a week

4-Two or more times a week
c.

Crabs, shrimp or other shellfish caught in an
unknown location that was given to you or purchased
from a vendor, grocery store or restaurant.
Please include both fresh and frozen shellfish.

0-Never or almost never
1-Less than once a month
2-About once or twice a month
3-About once a week
4-Two or more times a week

d.

Fish caught in this area including lakes, rivers,
streams, and the Great Lakes. Please include fish
caught by you or someone you know as well as
locally-caught fish purchased from grocery stores,
vendors, or restaurants.

0-Never or almost never
1-Less than once a month
2-About once or twice a month
3-About once a week
4-Two or more times a week

e.

Fish caught in this area including lakes, rivers,
bays, ship channels, local ocean waters and the Gulf
of Mexico. Please include fish caught by you or
someone you know as well as locally-caught fish
purchased from grocery stores, vendors, or
restaurants.

0-Never or almost never
1-Less than once a month
2-About once or twice a month
3-About once a week
4-Two or more times a week

f.

Crabs, shrimp or other shellfish caught in this area
including lakes, rivers, streams, and the Great Lakes.
Please include fish caught by you or someone you
know as well as locally-caught fish purchased from
grocery stores, vendors, or restaurants.

0-Never or almost never
1-Less than once a month
2-About once or twice a month
3-About once a week
4-Two or more times a week

g.

Crabs, shrimp or other shellfish caught in this area
including lakes, rivers, bays, ship channels, local
ocean waters and the Gulf of Mexico. Please include
fish caught by you or someone you know as well as
locally-caught fish purchased from grocery stores,
vendors, or restaurants.

0-Never or almost never
1-Less than once a month
2-About once or twice a month
3-About once a week
4-Two or more times a week

6.

Out of the past 10 years, how many years have you
eaten fish or shellfish that were caught in local waters,
including lakes, rivers, streams, and the Great Lakes?
Please include fish caught by you or someone you know
as well as locally-caught fish purchased from grocery
stores, vendors or restaurants.
7.
Out of the past 10 years, how many years have you
eaten fish or shellfish that were caught in local waters,
including lakes, rivers, bays, ship channels, local ocean
waters and the Gulf of Mexico? Please include fish
caught by you or someone you know as well as locallycaught fish purchased from grocery stores, vendors or
restaurants.

8.

How many types of fish or shellfish caught from this
area did you eat most often over the past 12 months?
Please list the top three types and where they were
caught.

(yrs)

(yrs)

Interviewer: Provide a reference map to help participant
determine where fish were caught.
Type of Fish or Shellfish

Water Body Where Caught

1.
2.
3.

9.

On average during the past 12 months,
approximately how many caffeinated beverages did you
drink in a typical day? (One caffeinated beverage equals
a small cup of coffee or tea, or a can of cola or other
caffeinated soft drink such as Mountain Dew).
Interviewer: Fill in "0" if none.

10.

(drinks per day)

What type of underwear do you wear during the day?
0-None
1-Briefs
2-Boxers
3-Boxer-briefs
4-Other
a.

11.

Specify:

What type of underwear do you normally wear to
bed?

0-None
1-Briefs
2-Boxers
3-Boxer-briefs
4-Other

a.

Specify:

I am now going to ask you about your use of tobacco and alcohol products. Please give me your best answer even if you
are not entirely sure about your answer.
12.

Have you smoked more than 100 cigarettes (5 packs)
during your lifetime?

13.

How old were you when you first started smoking
regularly, that is daily or nearly everyday?
Interviewer: Fill in "99" if participant never smoked
regularly.

0-No

1-Yes

14.

Have you smoked in the last 12 months?

0-No

1-Yes

15.

Do you smoke now?

0-No

1-Yes

a.

Approximately how many cigarettes do you smoke
on a typical day?
Interviewer: If less than one per day please fill in "1".

16.

When you last smoked, approximately how many
cigarettes did you smoke on a typical day?
Interviewer: If less than one per day please fill in "1".

17.

How old were you when you quit smoking regularly?

18. Have you used any of the following tobacco products at least 20 times in your entire life?
a.

Smoked a pipe?

0-No

1-Yes

b.

Smoked cigars?

0-No

1-Yes

0-No

1-Yes

0-No

1-Yes

c.

Used snuff such as Skoal, Skoal Bandit or
Copenhagen?
d.
Used chewing tobacco such as Redman,
Levi Garrett or Beechnut?
19.

Do you currently smoke a pipe?
0-No
1-Yes, some days
2-Yes, every day
a.

20.

How many pipefuls of tobacco do you typically
smoke per day?
Interviewer: If less than one per day please fill in "1".
Do you currently smoke cigars?
0-No
1-Yes, some days
2-Yes, every day

a.

21.

How many cigars do you typically smoke per day?
Interviewer: If less than one per day please fill in "1".
Do you currently use snuff?
0-No
1-Yes, some days
2-Yes, every day

a.

22.

How many "pinches," "dips," or "rubs" of snuff do
you typically use per day?
Interviewer: If less than one per day please fill in "1".
Do you currently use chewing tobacco?
0-No
1-Yes, some days
2-Yes, every day

a.

23.

How many "plugs," "wads," or "chaws" of chewing
tobacco do you typically use per day?
Interviewer: If less than one per day please fill in "1".

In the past 12 months, have you had at least 12
drinks of any kind of alcoholic beverage?
Interviewer, read if necessary: Alcoholic beverages
include beer, wine, wine coolers, or liquor.
a.

Approximately how often did you drink some kind

0-No

1-Yes

of alcoholic beverage?

1-Less than once a month
2-Once a month
3-Two or three days a month
4-Once a week
5-Two or three times a week
6-Four to six times a week
7-Every day

b.

Approximately how many alcoholic drinks did you
have on a typical occasion?
Interviewer, read if necessary: One drink equals a
can or bottle of beer, a glass of wine, a shot of liquor,
or a mixed drink.
Interviewer: If less than one per day, fill in "1".

1-One drink
2-Two drinks
3-Three drinks
4-Four drinks
5-Five drinks or more

c.

Was there ever a single occasion during which you
drank five or more alcoholic drinks?
Interviewer, read if necessary: Again one drink
equals a can or bottle of beer, a glass of wine, a shot
of liquor, or a mixed drink.

0-No

1-Yes

The next four questions ask about your feelings and thoughts during the last month. In each case, please tell me how
often you felt or thought a certain way.
24.

In the last month, how often have you felt that you
were unable to control the important things in your life?
Did you feel that way...

0-Never
1-Almost never
2-Sometimes
3-Fairly often
4-Very often

25.

In the last month, how often have you felt confident in
your ability to handle your personal problems? Did you
feel that way...

0-Never
1-Almost never
2-Sometimes
3-Fairly often
4-Very often

26.

In the last month, how often have you felt that things
were going your way? Did you feel that way...

0-Never
1-Almost never
2-Sometimes
3-Fairly often
4-Very often

27.

In the last month, how often have you felt difficulties
were piling up so high that you could not overcome
them? Did you feel that way...

0-Never
1-Almost never

2-Sometimes
3-Fairly often
4-Very often

LIFE
$sitecode

User:

System Date:

Mode: Production

Site Name:

Male Demographics (DMM)
Version: 3.00; 08-15 -06

Before the end of the interview, I'd like to ask you seven final questions.
1.

2.

What is your date of birth?

Which of the following categories best describes your
current level of education?

(mm/dd/yyyy)

1-Less than high school graduate
2-High school graduate/GED
3-Some college or technical school
4-College graduate or higher

3.

Which of the following best describes your ethnicity?
1-Hispanic or Latino
2-Not Hispanic or Latino

4. Which of the following best describes your race? (Please indicate all that apply)
a.

American Indian or Alaska Native:

0-No

1-Yes

b.

Asian:

0-No

1-Yes

c.

Black or African American:

0-No

1-Yes

d.

Native Hawaiian or Other Pacific Islander:

0-No

1-Yes

e.

White:

0-No

1-Yes

f.

Other:

0-No

1-Yes

What race best describes you?

5. Please look at this card and tell me which letter best represents your household income (either annual or monthly) before taxes in
the last 12 months, including income from wages, salaries, social security or retirement benefits, help from relatives and other
sources of income. This includes income from all individuals living in your home.
Interviewer: Hand show card to participant.

a - Less than $10,000 (less than $833 per month)
b - $10,000-$19,999 ($833-$1,666 per month)
c - $20,000-$29,999 ($1,667-$2,499 per month)
d - $30,000-$39,999 ($2,500-$3,332 per month)
e - $40,000-$49,999 ($3,333-$4,166 per month)
f - $50,000-$59,999 ($4,167-$4,999 per month)
g - $60,000-$69,999 ($5,000-$5,832 per month)
h - $70,000-$79,999 ($5,833-$6,666 per month)
i - $80,000-$89,999 ($6,667-$7,499 per month)
j - $90,000-$99,999 ($7,500-$8,332 per month)
k - $100,000 or over ($8,333 and over per month)

6.

How many people live in your household?

7.

Do you currently have a source of health insurance
(e.g. private health insurance, Medicaid, or military or VA
health insurance)?

0-No

1-Yes

8.

Do you have access to a computer with an Internet
connection?
Please indicate all that apply (read choices):

0-No

1-Yes

at home
at work
friend or relative
library

Now that we have completed the questionnaire, I am going to take your weight and several other body measurements.
Later I will instruct you in the daily use of your diary. Thank you again for your cooperation.

First Measurement

9. Weight:
(kg)
10. Height:
(cm)
11. Waist:
(cm)

Second
Measurement

Third Measurement

Self Reported Weight
(If the participant will not stand on the
scale or if weight is beyond scale limit
of 330 lbs)
(xxx lbs)

(xxx.xx)

(xxx.xx)

(xxx.xx)

(xxx.x)

(xxx.x)

(xxx.x)

(xxx.x)

(xxx.x)

(xxx.x)

Thank you for your cooperation in answering all of my questions. For future purposes, such as sending you newsletters
and providing you with the results of the study, I would like to get some additional contact information from you.
Thank you.

After saving, be sure to obtain the participant's complete contact information.