Focus Group Registration

What is Market Research Focus Groups ?
It is how companies gain feedback from the community about current or future products/ services. Market research discussion groups may involve observation techniques, such as viewing or recording.

.You will receive an incentive payment, as a thank-you for your contribution. Which ranges from $50 and above.

.Successful focus groups depend on the 'right' people attending. So, we have a large database of all 'types' of people to ensure we can meet our clients research requirements.

Who are we ?
We have been in operation for over 5 years.

Your information is treated with the utmost confidentiality and is held in a physically secure and access limited environment. Your information will only be seen & used by us and only for market research purposes.

Next step:
If you would like to be added to our database, as available to attend Group Discussions/Product Testing, please fill out the questionnaire below. We will periodically email or phone you to see if you are suitable for current projects.

^* Please answer as many questions as possible, the more information you can give us the easier it is for us to match you to specific market research project.
* We expect our respondents to answer all questions honestly and accurately. Those found to be doing otherwise will go on a 'Do Not Use' Register.

	This questionnaire should be filled out by any person over 18 years of age who is interested in attending MR discussions.


1.	First Name :
2.	Surname :	Title:
	Add/Update Information ?
3.	Address :	(optional)
	Suburb:
	Postcode :	State :
		...
4.	Telephone - Home :
	Telephone - Work :
	Telephone - Mobile :	Plan:
		Mobile Provider:
5.	Email Address :	* We may email you from time to time regarding groups, enter 'OPT OUT' in the Email Address if you do not wish this to happen.
	Email Check Frequency :
		...
6.	Your Gender :
	What is your marital status :
	What is your Nationality :
	Date of Birth :	Day (01-31) / Month (01-12) / Year (1900-)
	Areas in which you would prefer to attend groups:
		...
7.	Job Title :	(10 characters max.)
	Employeed Status :
	Self Employed :	Business turnover (approx):
	Which of these would best describe your occupation (ABS codes) :
	What Industry Type :
	Suburb in which you Work:
	What is your partners occupation (if applicable)	(10 characters max.)
		...
8.	Do you drink ? (mark whichever apply) :	Beer Wine NON-Drinker
		...
9.	Credit cards held (choose whichever apply) :

10.	What bank do you have your main account with :
	What Building Society do you have an account with :	(10 characters max.)
	What type of account(s) do you have?	Savings Account Cheque Investment
		...
11.	These questions relate to your main car(s):
	Car Make :
	Car Model :
	Year of Manufacturer :
	Car insured with :	(10 characters max.)
	Is this a company car :
	Are you a member of the RACV:
		...
12.	Do you have pets (how many):	Cat Dog

13.	Do you have any children living at home, if so what is their year of birth :	Child BOY, year of birth (YYYY): Child BOY, year of birth (YYYY): Child BOY, year of birth (YYYY): Child GIRL, year of birth (YYYY): Child GIRL, year of birth (YYYY): Child GIRL, year of birth (YYYY): Are they interested in attending Groups ? :
		...
14.	Into which of the categories listed does the income of the entire household belong? (*ABS categories)
		...
15.	Do you smoke cigarettes :
	Do you own a Personal Computer :
	Do you wear spectacles/ contact lenses :
	Favourite Radio Stations::
	Do you travel on business :
	Do you have Pay TV :
	Do you have Private Health Insurance with :
	How did you hear about us :
	Comments :



		Thank you