Focus Group Registration - Group Dynamics

Your opinions are needed!

Group Dynamics invites you to share your opinions and ideas about products and services. It is easy to participate . . .

Just fill out our short questionnaire that tells us about yourself and your interests. This will register you in our database or update your record if you have participated in the past. We follow the practices endorsed by the National Marketing Research Association (MRA) and the Council for Marketing and Opinion Research (CMOR).

Anyone living in Philadelphia, Surrounding Counties or South Jersey can participate. We invite people of any age and all walks of life to give their opinions in a relaxed and comfortable setting.

Why participate?

Your responses are confidential and necessary to clients for improving their products and services or creating new ones - AND you are paid for your time.
Please view our privacy policy.

You must make a firm commitment to attend if you qualify. We expect a call to cancel if the need arises so you can be replaced.

Please complete the form below:

1.) First and Last Name:*
2.) Address: Street*
Apartment / Floor / Suite:
City:*
State:*
Zip Code:*

3.) Home Phone:*
Cell Phone:
4.) Email address:*

5.) Gender:*		Male Female
6.) What best describes your Race/Ethnic Background:*		African American Caucasian Asian Hispanic/Latino Native American Other
7.) Date of Birth:*
8.) Highest level of education completed:*
9.) Marital Status:*
10.) Child/Children under 18:*		Yes No
11.) Pets:		Yes No
12.) Smoking:*		Yes No
13.) Occupation:
14.) Employer:
15.) Household income before taxes:

16.) Do you have any medical conditions?
Please List (Leave blank if none.):

17.) How did you hear about us?:*

Newspaper / magazine ad or article		Name of newspaper / magazine:
Friend		Name of Friend:
Workplace
GroupDynamics.com
Another website		Website address:
Search Engine
Conference
Flyer / Mailer
Yellow Pages

* Required Fields

555 City Avenue, 6th Floor, Bala Cynwyd, PA 19004

Phone: 866-221-2038 • Fax: 610-668-2072