| The solution site for focus groups in cities with no facilities. |
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Focus group setup and recruiting in any market |
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You must use a modern web browser (> version 4) and have JavaScript support enabled to complete this form.
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Participant Profile
The Participant Profile below provides us with all the information we need
to consider you for future studies by FocusAnywhere and its affiliated
research firms EyeQ, Consumer Logic, and The NorthStar Group.
As you fill it out, keep in mind that companies have research needs that
include a wide variety of people. So, be sure that your profile accurately
reflects YOU.
Please complete all blanks. (If you choose not to complete some of the
blanks, you will be excluded from some studies, due to the lack of profile
information.)
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First Name
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Last Name
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What is your Date of Birth?
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What is your Gender?
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Home Phone
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()
(No Hyphens Please)
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Work Phone
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()
(No Hyphens Please)
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| Do you own a cell phone? |
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Cell Phone
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()
(No Hyphens Please)
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What is your home street address?
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City
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County/Parish (not country)
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Zip Code
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Do you have an Email Address?
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Email
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What is your current marital status?
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Do you own or rent your current home?
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What is your current employment status?
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Which of the following BEST
describes your occupation?
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What is your current voter status?
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Do you have a computer in your home?
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Do you have internet access at home?
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What is the highest level of
education you have completed?
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What do you consider to
be your ethnic background?
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Which of these ranges
includes your total annual
household income before taxes?
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Do you have any children in your
household under 18 years of age?
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We conduct many projects that want to hear the opinions of adults with children of specific ages in their household.
If you answered ‘Yes’ to the above question please tell us the gender and date of birth of each child in your
household, starting with the youngest and ending with the oldest.
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Child 1: Gender
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Birthdate
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Child 2: Gender
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Birthdate
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Child 3: Gender
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Birthdate
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Child 4: Gender
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Birthdate
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Child 5: Gender
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Birthdate
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Child 6: Gender
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Birthdate
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Do you use any tobacco products?
If YES, What brand do you use most often?
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What are your two favorite
radio stations for music?
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Do you pay for a satellite radio
subscription in any of your automobiles?
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How did you hear about
the FocusAnywhere website?
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Click SUBMIT only once.
Submitting more than one Profile
will NOT increase your chances of being selected for a study.
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