If you would like to be contacted occasionally and be paid for giving your honest opinion, positive or negative, please fill out the following information about yourself and your household.
Note: All the information in this form is and will remain strictly confidential. Your name will not be sold to any mailing lists. We will use this information as a guide to call you for paid focus groups and interviews ONLY. If you feel uncomfortable answering some questions, simply leave them blank; the more information we have, however, the easier it will be to find focus groups for which you may qualify. * denotes required fields.
If you would prefer to fill out this form in Spanish, CLICK HERE.