Registration Form

 

Fields marked with a * are mandatory

 

Title
First Name*
Last Name*
E-Mail 1*
E-Mail 2
Home Address*

County*

Post Code*
 
Daytime Telephone*
Evening Telephone*
Mobile Number *

Date of Birth (DD/MM/YY):*

Marital Status *
Ethnic Origin
What is your faith/belief?

If not born in the UK: How many years have you lived here?

Gender*
Preference*
Level of Education
Employment Status
Job Title
Industry
Are you the head of the household?
If not, head of household occupation
industry

Are you a decision maker when it comes to purchasing products and services on behalf of your company?
Residential status
Do you have children?
How many children live at home?

What cars do you own in your household?

 

  

CAR 1:

Make

Model

Year

 

 

CAR 2:

Make

Model

Year

 

 
Mobile Tariff
Mobile Network
Do you use the internet?
Do you use the internet at work?
Do you use the internet at home?
What type of internet service do you have?
How would you rate your computer skills?
Do you buy products or services online?
Do you use internet banking?
If yes, who with? 

 

Who do you do your daily banking with?

Lloyds TSB

Natwest

Abbey National

Barclays

Halifax

RBS

C & G

HSBC

 

 

 

 

 
Any others? Please state

 

Do you own any of the following?

Digital Camera

Digital Video Camera

DAB Radio

PDA

iPOD

 
  
Do you have satellite/digital TV?
   

Which of the following do you drink?

Lager

Beer

Wine

Spirits

Champagne

 

  

Do you smoke?

Wear glasses?

Wear contacts?

Are you Vegeterian?

Have you attended any focus groups within the last 6 months?

 

Are you registered with any other recruiters for focus groups?

If Yes, who with?
How did you hear about us?