This is our ONLINE PARTICIPATION FORM. The information that you provide will allow us to contact you at different times to pre-screen you for the different types of focus groups that we conduct on behalf of our clients. By submitting this information you are giving us permission to contact you for this pupose. For more information, please be sure to read our Privacy Statement.
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Employment Status Select Full Homemaker Not Working Part Time Self Employed Retired Student
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Income Select Refused Under $30,000 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $109,999 $110,000 - $129,999 $130,000 - $149,999 $150,000 - $174,999 $175,000 - $199,999 $200,000 - $249,999 $250,000 - $299,999 $300,000 - $399,999 $400,000 or more
Education Select Less than High School High School Grad. Some College Associate's Degree College Grad. Post Grad. Doctorate/M.D.
We often conduct toy research with children. If any children, 17 or younger, are living in the household, please indicate name, gender, and date of birth below.
NameChild 1
Birthdate
Gender Gender Female Male
NameChild 2
Child 3
Gender Female Male
Child 4
Hobbies
Household Vehicles:
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Vehicle #1:
Vehicle #2:
Vehicle #3:
Who is your Internet service provider?
What is your Internet connection speed? Select Don't Know Less than 28.8 Kbs 28.8 Kbs 56 Kbs ISDN DSL Cable T1 Fiber Optic Other
Types of Computers Hours of TV watched per week: Hours of Prime Time TV (8-11pm) p/week:
Video Game (Console) Models My favorite TV shows are (List all):
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