Register – Insight Focus Groups

If you would like to take part in some market research please fill in the details requested. The more information we have on you the more likely we are to find some research that will be of particular interest to you.

At Insight Focus Groups we value your privacy – you will not receive sales calls or direct mail as a result of giving us your name. Your details are strictly confidential.

Please complete the form in full.

You do need to answer every question in order to be considered for groups.

Data Consent

Data consent

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Please choose one of the following options before entering any details. There is a page on Data under About Us on this website with more information should that be required.

Personal Information

Title *

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First name *

Surname *

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Sex

Male

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Date of Birth [dd/mm/yyyy]

Marital Status

Ethnicity *

Other Ethnicity

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Contact Information

Address *

Address 2 (Area/District) *

Post code *

Email *

Please supply as many contact numbers as possible so I can get hold of you if the right research comes in.

Home Phone *

Work Phone *

Mobile Phone *

Mobile Phone Provider *

Employment

Working Status

Job Title

Industry

Post code of job location

Partners Job Title

Bank Information

Bank Name

Who you bank with

Other

Savings Bank

Other

What is your Life Stage *

Please tells us whether you have any children by choosing your life stage in your drop down below.

Life Stage

Child 1 Gender and D.O.B

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Child 1 Date of Birth [dd/mm/yyyy]

Child 2 Gender and D.O.B

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Girl

Child 2 Date of Birth [dd/mm/yyyy]

Child 3 Gender and D.O.B

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Girl

Child 3 Date of Birth [dd/mm/yyyy]

Child 4 Gender and D.O.B

Boy

Girl

Child 4 Date of Birth [dd/mm/yyyy]

Market Research Background

Are you also available for daytime Market Research? *

Yes

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