Market Research - Group Discussion Form (29/10/08)

Corner the Market

Register HERE for Research Group Discussions
( Earn $'s for your opinion)

Telephone No.: 03 9471 1590 or 0402 835 818

Contact: Michelle Isdale

The companies organise group discussions or focus groups, clinics, accompanied shops, affinity groups & face-to-face interviews.These groups, which are held in metropolitan Australia, normally consist of 4-10 people, last for 1-2 hours and pay a cash incentive that is usually around $50 - $100 per person.

If you are interested in attending such Focus Groups and being added to our database please complete the questionnaire below and hit “Submit”. This information helps us to ensure that we recruit the appropriate people for each research group.

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NOTE: Your privacy – We adhere to the National Privacy Principles, as laid out in the Privacy Amendment (Private Sector) Act 2000 and so you can be assured that your information will be treated with the upmost confidentiality

1.	Surname :
2.	First Name :	Title:
3.	Address :
	Suburb:
	Postcode :	Area:
		...
4.	Telephone - Home :
	Telephone - Work :
	Telephone - Mobile :	Plan:
		Mobile Provider:
5.	Email Address :	* We may email you from time to time regarding groups, enter 'OPT OUT' in the Email Address if you do not wish this to happen.
	Email Check Frequency :
		...
6.	Your Gender :
	What is your marital status :
	What is your Nationality :
	Date of Birth :	Day (01-31) / Month (01-12) / Year (1900-)
	Group Area Preferred:
		...
7.	Job Title :	(10 characters max.)
	Employeed Status :
	Self Employed :	No. of Employees:
	Which of these would best describe your occupation (ABS codes) :
	What Industry Type :
	What is your partners occupation (if applicable)	(10 characters max.)
	Highest level of education achived	(10 characters max.)
		...
8.	Do you drink ? (mark whichever apply) :	Beer Wine Spirits NON-Drinker
		...
9.	Credit cards, (choose whichever apply) :

10.	What bank do you have your main account with :
	What Building Society do you have an account with :	(10 characters max.)
	What type of account(s) do you have?	Savings Account Cheque Investment
		...
11.	These questions relate to your main car(s):
	Car Make :
	Car Model :
	Year of Manufacturer :
	Car insured with :	(10 characters max.)
	Is this a company car :
	Are you a member of the RACV :
		...
12.	Do you have pets :

13.	Do you have any children living at home, if so what is their year of birth :	Child BOY, year of birth (YYYY): Child BOY, year of birth (YYYY): Child BOY, year of birth (YYYY): Child GIRL, year of birth (YYYY): Child GIRL, year of birth (YYYY): Child GIRL, year of birth (YYYY): Are they interested in attending Groups ? :
		...
14.	Into which of the categories listed does the income of the entire household belong? (*ABS categories)	Under $10,000 per year 10,000 -$19,990 per year 20,000 - $29,990 per year 30,000 - $49,990 per year 50,000 - $69,990 per year 70,000 - $89,990 per year 90,000 or more per year
		...
15.	Do you smoke cigarettes :
	- thinking of quitting ?
	Have any Medical Conditions :
	Do you have Investment Property :
	Home Ownership :
	Home Insurance with :	(10 characters max.)
	Do you have Pay TV :
	Favourite radio station :	(10 characters max.)
	Do you have Private Health Insurance with :
	How did you hear about us :
	Comments :


		Thank you

Keywords: Recruitment, Market Research, market research recruitment, group discussions, focus groups, Australia Research, market research focus groups, focus group recruiting software, market research recruiting software,www.altafx.com