WELCOME TO FIELD & FOCUS    

  PARTICIPATE

Field & Focus regularly seeks local consumers and business decision makers to participate in market research studies. These studies are quite interesting and informative and our participants are always compensated for their time and the sharing of ideas.

If you are interested in becoming a participant, please complete the information below and send it back to us.

This way, we may contact you when we are conducting studies which may be of interest to you.

 
Name:   Address:
City:   Zip Code:
Mobile
Telephone:		      
Telephone
Day: 		 

Telephone
Evening:

E-Mail:   Year Born:
Education:   Occupation:
Company Type:   Race/Ethnicity:
      If Other, please specify:
Household Income:   Own/Rent Home:
Marital Status:      
If you have children, how many?   Number of Children:
Please enter the gender and year born for each child.
Child#1 Gender   Year Born:
Child#2 Gender   Year Born:
Child#3 Gender   Year Born:
Child#4 Gender   Year Born:
Child#5 Gender   Year Born:
Child#6 Gender   Year Born:
If married or living as married, “Would your spouse or partner be interested in participating if our research projects?” Yes       No
If yes, for spouse, please provide the information below.  
Name:   E-Mail (if different):
Mobile
Telephone: 		     
Telephone
Evening (if different): 		  Telephone
Daytime (if different):
Year Born:   Education:
Occupation:   Company Type:
Race/Ethnicity:   If Other, please specify: