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Thank you for your interest in our upcoming focus groups in Baltimore in September.

This information is for research and screening purposes only and will be kept confidential. It will not be shared, and you will not receive marketing offers as a result of completing this form. Upon completion of each group, participants will receive $100 in thanks for their time and effort to attend, which you may keep or donate as you see fit..

If you have any problems with this form, please contact susan@opinionworks.com.

1. Please provide your contact information so we know how to get in touch with you. *This question is required.

Name
Email (please confirm carefully):
City
State
Zip code
Best telephone number to reach you