Join a Focus Group

Capitol Research Services is always looking for new market research participants for upcoming focus groups. Frequently you will receive cash or a gift certificate in appreciation of your time and opinions. Please take a few minutes to fill out information about yourself. All information is kept strictly confidential. Thank you!

First Name:

Last Name:

Male    Female







Date of Birth:

Are you a registered voter:
Yes    No

What is your current marital status:
Single     Married     Divorced     Widowed

Do you have children:
Yes    No

If yes, what is their birth year and gender:

What is your current emplyment status:
Full Time     Part Time     Student     Retired     Unemployed    

If employed, what is your occupation:

What is the highest level of education you have completed:
Less than high school     High School     Some College     College Graduate     Gradute College    

What is your racial or ethnic classification:
African American     Asian/Pacific Islander     Caucasian     Hispanic-Latino     Native American     Other    

If other:

What is your approximate total annual household income before taxes:
Under $30,000     $30,001 to $50,000     $50,001 to $75,000     $75,001 to $100,000     More than $100,000    

What county do you live in:
Ingham     Eaton     Clinton     Shiawassee     Jackson     Livingston     Ionia     Other    

If other:

How did you find out about us: