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Please complete a profile on-line so that we can find a paid focus group that suits your interests.

If you have any questions, feel free to call us at: Advanced Focus 212.217.2000

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General Information

First name

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Last name

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Home phone

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Work phone

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Cell phone

Fax

Email

 

 

Home Address

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City

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State

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Zip

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Gender

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Date of birth

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Ethnicity

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Household income

Personal Income

Education

 

 

Employment Information

What is your employment status?

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Job title

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Employer's name

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Position

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Number of employees who report to you

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Industry

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Your company's annual sales

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Number of employees locally

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Number of employees world-wide

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Number of computers at your workplace

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What social/professional networking sites do you have an ACTIVE account with?
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Computers & Technology

Do you use a computer at work?

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Type(s) of computer (Hold the <ctrl> key down to select/unselect multiple responses)s

 

 

Vehicles

Please indicate your 2 newest automobiles.

 

 

Make

Model

Year

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Model

Year

 

 

Referral Source

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Executive/National Headquarters 44 East 32nd Street, 4th Floor • New York, NY 10016 • telephone:212.217.2000 • fax:212.217.2007
The Facility 373 Park Avenue South, 8th Floor • New York, N.Y. 10016 • telephone:212.684.2000 fax:212.684.2677