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Thank you for your interest in our upcoming focus groups in Warminster and Carlisle, PA in November. 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 questionnaire. Upon completion of each group, participants will receive $100 in thanks for their time and opinions.

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

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1. Please provide your contact information so we know how to get in touch with you. *This question is required.
2. 1. What is your age? *This question is required.
3. 2. What is your gender? *This question is required.