Focus Group Inquiry
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| Your Name* |
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| Organization* |
|
| Phone* |
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Email
|
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| Desired Date* |
MM |
/ |
DD |
/ |
YYYY |
|
Alternate or Additional Date
|
MM |
/ |
DD |
/ |
YYYY |
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Room Set Up
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Clients & respondents in the same room
Clients in a separate observation room
Clients not attending groups – no extra room required
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AV needs (Select all that apply)
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LCD Projector and Screen
Laptop Speakers
37″ Flat Panel TV with DVD Player
Digital Video Recording (stationary/unmanned)
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Other Facility Requirements:
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Do you want a recruitment referral?
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Yes
No
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How did you find us?
* |
I’m already a client
Google or online search
CTA advertisement
Magazine advertisement
Ignite Theatre
A friend or colleague sent me
I attended an event at Catalyst Ranch
Facebook
Twitter
Yelp
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