CONSUMERS ARE OUR BUSINESS

Are you interested in being a participant in a study?  We will pay for your opinions!!  Fill out our participant form to give us information about you so you can be considered for future studies.  The information you submit will be evaluated and your responses will determine which focus groups you will be eligible for.  You will then receive a phone call at which time you will be asked some additional questions about the topic to be discussed.  If you qualify and are available to attend, we will reserve a seat on the panel for you and provide you with all the details.  After the panel is completed, you will be paid a cooperation fee for your participation.

Particpant form:

Please fill out the following Data Registration Sheet as completely as possible.  You may leave out any information that you do not wish to share, but the more information you give us will broaden the number of studies that you may qualify for.

NOTE: All information is for internal purposes only and will not be given to any other company or organization.

Name:
E-mail:
Street address:
City:
State:
Zip: -
Home phone: () -
Mobile/Alternate phone: () -
Work phone: () -x.
Age:
Gender:
Ethnicity:
Occupation:
Employer:
Is that full time
or part time?
Full Time Part Time
Industry:
Company size:
Do you travel for business? No
Yes, domestically
Yes, internationally
Yes, domestically and internationally
Household income:
Marital status:
Last grade of school completed:
Children:
Would this child
like to participate?
Male Female Age Yes No
Best time to call:
Availibility to go on panels:
(Check all that apply)
Weekdays
Weeknights
Weekends
Have you ever participated in a focus group discussion? Yes
No
If yes, when was the last time you participated?
Do you own a car or truck? Yes No
If yes, indicate years and models: Car/Truck 1:
Car/Truck 2:
Car/Truck 3:
Car/Truck 4:
Do you smoke? Yes No
If yes, which brand and size? Brand:
Size:
What type of computer do you own? IBM compatible
Macintosh
Other
Don't own a computer
Don't Know
Would you consider yourself a beginner, intermediate, or advanced internet user? Beginner
Intermediate
Advanced
Do you shop online? Yes No
Do you trade stocks online? Yes No
Are you fluent in Spanish? Yes No

How did you learn about us?