Registration

Please fill out the application form below. You do not have to complete every field, but the more you do the more likely it is that we can use you.

We cannot guarantee the number of focus groups that you will be offered, as this will depend on the criteria laid down by our clients. The Market Research Society Code of Conduct ensures that the information you give is confidential and will not be passed on to another company and that you will not receive sales or direct mail as a result of enrolling with us.

To complete your registration there is a Ten pounds (10 GBP) annual fee which is fully refundable or will be carried over to the following year if you are not selected for a research.

Every opportunity will be emailed direct to your email address and if you consider yourself to be suitable you can apply.

 

Title *

Select oneMrMsMissMrs

First names *

Surname *

Date of birth *

Status *

Select oneSingleMarriedCo-HabitatingDivorcedWidowedSeparated

Address Line 1 *

Address Line 2

City *

Post code *

London zone

Select one123456Outside London

Home telephone no *

Work telephone no

Mobile no

Email *

Mobile phone tariff

Select oneNo mobile phoneContractPays as you go

Mobile network

Dwelling type

Select oneFreeholdLeaseholdRented

Children living at home

Name

Date of birth

Sex

Child 1

Select oneMaleFemale

Child 2

Select oneMaleFemale

Child 3

Select oneMaleFemale

Child 4

Select oneMaleFemale

Child 5

Select oneMaleFemale

Have you been to College/University/other further training? *

Select oneNoneCollegeUniversityOther further training

Please specify any educational degrees or professional qualifications

What is your ethnic group? *

Select oneWhite BritishOther WhiteMixed White and Black CaribbeanMixed White and Black AfricanMixed White and AsianOther MixedIndianPakistaniBangladeshiOther AsianBlack CaribbeanBlack AfricanOther BlackChineseOther ethnic group

Religion

Select oneBudhistChristianHinduIslamJewishRoman CatholoicNoneOther

If not born in UK, how many years have you lived here?

Are you head of household? *

Yes No

Do you work? *

Select oneNoFull timePart timeRetiredStudent

Are you the main income earner? *

Yes No

Your job title *

Type of company

Employment *

Select oneEmployedSelf-EmployedUnemployedRetiredStudentOther

If self employed, how many employees do you have?

Select one12-56-1011-2021-5051-100100+

Job title of your partner

Type of company of your partner

Are they willing to take part in Focus Groups

Yes No

What car do you have? (MAKE)

MODEL

YEAR OF MANUFACTURE

Was it brought from new?

Yes No

What car does your partner have? (MAKE)

MODEL

YEAR OF MANUFACTURE

Was it brought from new?

Yes No

Are any other cars kept at home? (MAKE)

MODEL

YEAR OF MANUFACTURE

Was it brought from new?

Yes No

Are any other cars kept at home? (MAKE)

MODEL

YEAR OF MANUFACTURE

Was it brought from new?

Yes No

Who do you and your partner have credit cards with, please list

Do you have private health insurance?

Yes No

If so who with?

Who do you do your main shopping with?

Select oneASDATescoSainsburyMorissonsM & SSommerfieldIcelandBudgensLidlNettoWilkinsonsKwik SaveOther

Who do you do your Top up shop with?

Select oneASDATescoSainsburyMorissonsM & SSommerfieldIcelandBudgensLidlNettoWilkinsonsKwik SaveOther

Who do you buy your petrol from?

Select oneEssoShellBPMobilGulfTexacoQ8SupermarketOther

Do you bank online?

Yes No

If yes, who with?

Who is your mortgage with, please list?

Do you smoke?

Yes No

Do you gamble?

Yes No

Do you wear glasses?

Yes No

Do you wear contact lenses?

Yes No

Are you vegetarian?

Yes No

Which weight loss products have you tried?

Interest and hobbies. Please list

Have you attended focus groups within the last 6 months?

Yes No

Are you registered with any other recruiters for focus groups?

Yes No

If yes, who with?

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