FOCUS GROUP REGISTRATION FORM
Hello and Welcome !!! Thank you for your interest in becoming a part of our Focus Group Community. This community is a way for you to share your opinions about products and services and earn a monetary incentive (cash, check, gift cards). Your opinions will help to improve and develop new products. Please take a few minutes to complete the form below which will help us to learn more about you and the things you own and/or like that will help us qualify you for upcoming studies. Note: Registering with us simply entitles you to receive focus group notifications when suitable projects are available. We cannot guarantee you placement in groups as you must go through further qualification. Also, there is no obligation for you to participate in offered focus groups and you can request removal from our mailing list at any time. ****************************************************************************************** PRIVACY We respect the privacy of our respondents and clients and are committed to maintaining the security of personal information. We do not conduct sales or direct marketing. We do not rent, sell or provide information to any third parties. Your information is kept secure. WHAT TO EXPECT When a project is in the planning process, we will call or e-mail you to see if you qualify to participate. Every project has guidelines set by our clients. You will be asked a series of questions to see if you fit the guidelines set for the project and if so, you will be invited to participate in the study. There will be times that you may not qualify and if that does happen, you will remain in our database and receive communication for future studies. Participants in market research studies are compensated for their time with honorariums ranging from $25 - $300+. Everything shared in a focus group is kept strictly confidential and will never be used for anything other than the research that is being conducted. Information will not be shared, sold or bartered. GET PAID FOR YOUR OPINIONS.. LETS GET STARTED !
The information you provide here will give us an immediate sense of who you are. We respect the privacy of our respondents and we are committed to maintaining the security of personal information. Your information will not be sold, shared or bartered. It is strictly confidential and used strictly for the use of our market research recruitment purposes.
What is your date of birth?
What is your cellphone (or best) number?
What is your gender?
Other/ Prefer not to answer
What is your e-mail address?
What city and state do you reside in?
Are you a United States Citizen?
What is your ethnicity?
Are you employed...?
If you are currently unemployed, are you?
What is your job title? (Information shared is confidential)
What is your occupation or former occupation? (If Student, list your major)
In what industry do you work?
What is the highest level of education you have completed?
Less than HS/GED/HS Diploma/Technical Degree
2 Year College Degree
Some Post Grad
Post Grad Degree
What is your marital status?
Living w/ partner
Are you the head of the household?
Household Income What is your total household income (includes everyone in your home)?
Less than $25,000
$25,000 - $49,999
$50,000 - 74,999
$75,000 - 99,999
$100,000 - 150,000
$151,000 - 200,000
$201,000 - 250,000
How many children (under 18 years old) do you have living in your home?
more than 7
What are the ages AND genders of your children?
Are your children available to participate in groups as well?
Do you have a dog(s)?
Do you have a cat(s)?
Which major credit cards do you own?
American Express (Personal)
American Express (OPEN)
American Express CORPORATE
MasterCard (Debit or Personal)
None of the above
Which financial institution do you bank with?
Do you have a retirement plan (401K, IRA, etc)?
What type of cell phone do you own?
What is the make and model of your cell phone?
Who is your cell phone provider?
Please select all of the devices you own:
Laptop/Tablet hybrid 2-in-1
Wireless Controlled Speaker (Ex: Amazon Echo)
Do you accept text messages?
What is the latest time we may call or text you?
How did you hear about us?