FOCUS GROUP REGISTRATION
DO YOU WANT YOUR OPINIONS HEARD?
WANT TO BE PAID FOR YOUR OPINIONS?

Market research is a way for manufacturers and corporations to find out about consumers' attitudes and reactions to their products and services. It also gives you, the consumer, the opportunity to voice your opinion, and get paid for doing so. We think you'll find participating fun and interesting, and it's an easy way to earn extra money for yourself or your organization.

If you live in metropolitan Atlanta, please complete the following information and click below to submit, or print and send via US mail to
the address below or fax to (404) 892-8651. We will add your name to our database and phone you when we have different projects for which you may qualify.

You are never under any obligation to participate. We will ask you a series of questions to determine if you meet certain qualifications, if you do, you will be invited to participate in a particular project. If you agree, you will be given a specific date and time for the session, and you will be mailed a confirmation letter with all the information and directions to our facility. We will also call you the day before to remind you of the appointment. You will receive cash/check at the end of the session. If you live in the Atlanta Metropolitan area, we look forward to hearing from you. If you have any questions, please call us at (404) 892-2931 x 235. We want to hear from you!

First Name:
Last Name:
Home Phone:
Work Phone:
Cell Phone:
Address:
Apt#:
City:
State:
Zip:

DEMOGRAPHIC INFORMATION

Please check your gender: Male     Female
Please select your age group:


Please select your ethnicity:

     Other (Specify):
     If Hispanic or Asian - are you Bi-lingual?
           Yes     No
     If Bi-lingual, which language are you most comfortable with?

          


Your occupation/Job Title:
Job Industry:


If children under the age of 18 living at home please indicate sex, age & gender:
       Male     Female     Age
       Male     Female     Age
       Male     Female     Age
       Male     Female     Age


Spouse's Name: (if interested) N/A
Spouse's Work Phone:
Spouse's Cell Phone
Spouse's age group:
Spouse's ethnicity:
     Other (Specify):
Spouse's occupation/Job Title:
Spouse's Industry:


Total annual household income range: (not mandatory)

Which of the following do you own, use, or participate in:
     Cable TV
     Dine out on regular basis
     Satellite TV
     Smoke cigarettes
     Soft drinks
     Personal computer
     Play lottery games
     Internet
     Cellular phone
     Video games
     Car (Purchased new)
     Rent home
     Car (Purchased used)
     Own home
     Travel
     Travel by air
     Wine/Beer/Liquor
     Travel by Train
     Registered voter
          please indicate city/county (specify)

There is no selling involved and all your information is kept strictly confidential.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



1320 Ellsworth Industrial Blvd. • Atlanta, GA 30318 • phone 404-892-2931 • fax 404-892-8651
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