Focus Group Database Registration Your opinion matters! SIS is an international market research company and we regularly seek respondents who fulfill specific criteria to participate in our various paid research studies. These mainly consist of focus groups and one-on-one interviews. A focus group is an informal group discussion usually with 6-8 people on topics such as household appliances, headphones, cars, skincare products, etc. While you will not be compensated for filling out this survey, everyone who is chosen and actually participates in one of our groups or interviews does receive a monetary incentive for their time and insights, plus it is fun! This form allows you to provide your background and interests to potentially be considered for future studies. The information you provide to us will be stored in a secure, encrypted computer system. Please note that by submitting your contact information you agree to future communications from SIS International Research. If you no longer wish to be contacted, please submit your request in writing to [email protected]. The more details you provide us, the greater your chance is to be selected. Please take about 5 minutes and fill in all the questions. We look forward to meeting you at one of our studies. * * * * Please do not abreviate (Ex: New York, not NYC)" Select a State N/A Not Available Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming * If not in US, please select "N/A" * Select a Country United States United Kingdom Canada Australia India Ireland Hong Kong New Zealand Singapore Philippines N/A Not Available If not available, please select "N/A" Phone Number * * What is your Birthday? Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 * Gender Male Female * What is Your Marital Status? Married, Living with Spouse Divorced/Seperated Widowed Living Together Single, Never Married Single with Roommates * What is Your Ethnicity? White/Caucasian Hispanic/Latino Mid Eastern African American Pacific Islander Native American Japanese Chinese Indo-Asian Korean Taiwanese VietNamese Armenian Other * HOUSEHOLD INFORMATION | * denotes required field What is your annual household combined income? A - Under $15k $15k - $19k $20k - $24k $25k - $29k $30k - $34k $35k - $39k $40k - $49k $50k - $74k $75k - $99k $100k -$149k $150k - $199k $200k - $399k $400k and up Unknown * What kind of home do you have? Apartment Condo House Mobile Home Townhome * How Many people (other than yourself) live in your household? Please Select 0 1 2 3 4 5 * If you have other people living in your house, please provide the information below: PERSON #1 INFORAMTION | * denotes required field Gender Male Female Ethnicity White/Caucasian Hispanic/Latino Mid Eastern African American Pacific Islander Native American Japanese Chinese Indo-Asian Korean Taiwanese VietNamese Armenian Other Birthday Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 PERSON #2 INFORAMTION | * denotes required field Gender Male Female Ethnicity White/Caucasian Hispanic/Latino Mid Eastern African American Pacific Islander Native American Japanese Chinese Indo-Asian Korean Taiwanese VietNamese Armenian Other Birthday Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 PERSON #13 INFORAMTION | * denotes required field Gender Male Female Ethnicity White/Caucasian Hispanic/Latino Mid Eastern African American Pacific Islander Native American Japanese Chinese Indo-Asian Korean Taiwanese VietNamese Armenian Other Birthday Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 PERSON #4 INFORAMTION | * denotes required field Gender Male Female Ethnicity White/Caucasian Hispanic/Latino Mid Eastern African American Pacific Islander Native American Japanese Chinese Indo-Asian Korean Taiwanese VietNamese Armenian Other Birthday Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 PERSON #5 INFORAMTION | * denotes required field Gender Male Female Ethnicity White/Caucasian Hispanic/Latino Mid Eastern African American Pacific Islander Native American Japanese Chinese Indo-Asian Korean Taiwanese VietNamese Armenian Other Birthday Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 EMPLOYMENT HISTORY | * denotes required field What is your highest level of education? Less than High School Graduation High School Graduate Some College 2-Year College Grad 4-Year College Grad Postgraduate * What is your employment status? Full time Part time Self-Employed Not working Homemaker FT Student PT Student Retired * In what industry do you work? Aerospace Animal/ Pet Care Automotive Communications/ Media/ Arts Computer/ Info Technology Construction/ Interior Design Distribution Education Electronics/ Engineering Entertainment/ Film/ TV/ Music Finance/ Banking Government Hospital Hospitality (hotels) Insurance Law Enforcement Law/ Legal Management/ Consulting Manufacturing Medical/ Healthcare Non Profit Public Relations Publishing Printing Arts Protective Services Public Utilities Real Estate Restaurant/ Food Retail/ Wholesale/ Trade Service Industry Sports/ Recreation Transportation Travel/ Planning Telecommunications Unknown * Company Job title Are you an employer? Select One Yes No * How many local employees? 2-5 6-10 11-20 21-49 50-99 100-499 500-999 1000-4999 5000-9999 10,000k or more Unknown How many employees worldwide? 2-5 6-10 11-20 10-20 21-49 50-99 100-499 500-999 1000-4999 5000-9999 10,000k or more Unknown Other Assets & Income | * denotes required field How many automobiles do you own? # 0 1 2 3 4 * If you have an automobile(s), please describe them below:     Social Media & Referral Information Do you have a Facebook page? Do you have a LinkedIn profile? Were you referred to us by a friend? If so, please enter the email address of the person who referred you to our panel. * = Required Field