MarketWise Focus Group Data Base

Thanks for your interest in joining our database. Please fill out the form as completely as possible. When your information matches what our clients are looking for we will contact you to ask you some additional questions to see if you qualify.

1. Contact Information

First Name Required Question

Last Name

Street Address Required Question

City

State

Postal Code Required Question

Email Address Required Question

Phone Number Required Question

Mobile Phone

Website

2. Do you live in Charlotte or the surrounding areas?
Required Question

	Yes
	No

3. Are you or any close member of your family employed by a market research firm, an advertising agency, graphic design firm, TV,radio station or newspaper? Required Question

	Yes
	No

4. How many times have you ever participated in a research focus group -- that is an informal discussion group of 8 to 12 people? Required Question

5. What is your date of birth?
Required Question

6. What is your gender? Required Question

	Male
	Female

7. What county do you live in? Required Question

8. In order to fairly represent the population, I need to know if you are Required Question

9. Are you employed Required Question

10. What is your primary occupation? Required Question

11. What type of indusry do you work in? Required Question

12. What was the last level of education you completed?
Required Question

13. How many children under 18 do you currently have in your home?
Required Question

14. What is your primary grocery store or the store where you spend most of your grocery budget? Required Question

15. Approximately what is your total annual household income before taxes? Required Question

16. hat is your marital status? Required Question

	Married
	Separated, divorced
	Widowed
	Never been married

	Never
	One time
	Two times
	Three times
	Four times or more
	Refused

	Cabarrus
	Gaston
	Lincoln
	Mecklenburg
	Rowan
	Union
	York

	White
	Black
	Hispanic
	Other
	Refused

	Full Time
	Part-time
	Retires
	Homemaker
	Disabled
	Not Employed