What price Did you Choose? Survey data request

The What price did you choose? Survey data is available, on request, for free under a creative commons license. Fill out the form below and click on the button to submit your request for a copy.

Please indicate whether your request is private or for blogging/media purposes and include a link if possible.

This question is for testing whether you are a human visitor and to prevent automated spam submissions.
2 + 10 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.