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:


Gender:
Male    Female

Address:


City:


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Zip:


Phone:


Email:


Date of Birth:


Are you a registered voter:
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What is your current marital status:
Single     Married     Divorced     Widowed

Do you have children:
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If yes, what is their birth year and gender:


What is your current emplyment status:
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If employed, what is your occupation:


What is the highest level of education you have completed:
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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:


 

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crs@capitolresearchservices.com

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