Focus Group Participant Registration

Thank you for your interest in GSG. We are an public affairs and market research firm that conducts various types of qualitative panels. We are looking for people from all walks of life who enjoy sharing their opinions. As a token of appreciation we offer cash incentives to research group participants for their time.

By filling out the survey below you will automatically become registered in our database and eligible for consideration in future projects.

Our studies are purely for information gathering and we are not involved in the sale of any products or services. We are simply interested in learning the opinions of people in the New York area and beyond. All your responses to this survey will remain confidential.

We look forward to having you participate in one of our groups in the near future


PLEASE FILL OUT YOUR PERSONAL INFORMATION:

1. Name:  

2A. Address
2B. Address (cont.)
2C. City  
2S. State  
2Z. Zip (5 digits)  


3. What are the best numbers to reach you at when there are potential studies?

3D. Day Phone Number:
3E. Evening Phone Number:  
3C. Cellular Phone Number:


4. Email confirmation. Please put the email you would like to be contacted at.

  

5. What is your gender?  


6. When was the last time, if ever, that you participated in a market research group discussion, focus group, or individual interview?

 


7. What was the topic of the last group you attended?
(only answer if you have participated in a market research discussion, focus group, or individual interview)

8. Date of birth  


9. Would you describe yourself as...

 


10. Which of the following best describes your current title.
(answer only if you are employed)

 

10oth. What OTHER title?
(answer only if other in Q10 above)





11. What industry do you currently work in?
(answer only if you are employed)



12. How many employees are there in your organization?
(answer only if you are employed)

 

13. What kind of health insurance coverage do you currently have?

 

14. Which health insurance company are you currently enrolled with?
(answer only if you have coverage)
 

14oth. What OTHER insurance company?
(answer only if other on q14 above)



15. What is your current Marital Status?

 

16. Do you have any children? If yes, please specify the date of birth and gender of each.

DOB Gender

DOB Gender

DOB Gender

DOB Gender


17. Do you own or rent your home?

 


18. Which of the following represents your total 2008 household income before taxes?

 


19. How many airline trips have you taken in the past year for business or pleasure?
Number of business trips:
Number of pleasure trips:

20. Do you have cable, satellite, digital cable or TIVO at home?
(please check all that apply)
Cable
Satellite
Digital Cable
TIVO

21. Do you have either a computer at home or a computer at work, with Internet access, that you use?

 

22. Do you most often go on-line using a...

 

23. What kind of goods and services have you purchased online in the past 6 months?
(please check all that apply)
Computer Equipment
 Compute Software
 Books
 Music CDs/Tapes
 Travel Items
 Stocks/Mutual Funds
 Banking Services
 Health/Beauty Aids
 Clothing/Accessories
 Electronics

24. Are you registered to vote where you currently live?

 

25. When it comes to political parties, which political party do you most closely identify?

 

25oth. What OTHER party?
(answer only if other in q25 above)




26. What is the highest level of education you have completed?

 



27. For statistical purposes only, could you please tell me your ethnic background?

 


27oth. What OTHER ethnic background?
 (answer only if other in q27 above)

28. Do you consider yourself a Hispanic, Latino, or Spanish-speaking American?

 


28z. Do you consider yourself...
 

29. Finally, how did you hear about becoming a part of our research database?



29oth. How else did you hear about becoming a part of our research database?
(answer only if other in q29 above)