Focus Group Inquiry
Your Name
*

Organization
*

Phone
*

###		 –
###		 –
####
Email
*

Desired Date
*

MM		 /
DD		 /
YYYY
Alternate or Additional Date

MM		 /
DD		 /
YYYY
Room Set Up
 Clients & respondents in the same room 
 Clients in a separate observation room 
 Clients not attending groups – no extra room required 
AV needs (Select all that apply)
 LCD Projector and Screen 
 Laptop Speakers 
 37″ Flat Panel TV with DVD Player 
 Digital Video Recording (stationary/unmanned) 
Other Facility Requirements:

Do you want a recruitment referral?
 Yes 
 No 
How did you find us?
*
 I’m already a client 
 Quirks 
 Google or online search 
 A friend or colleague sent me  
 I attended a public event at Catalyst Ranch 
 I attended a social event at Catalyst Ranch 
 I attended a meeting at Catalyst Ranch 
 Facebook  
 Twitter 
 Yelp 
 Instagram 
Name of the person who referred you: