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GAMERS     
GamersWelcome Gamers! This is the place to sign up to do research studies and play testing on the hottest new games AND get PAID as well.

Fleischman Field Research does hundreds of groups each month, many of which are on new technology products, music and of course, Games! Qualified participants earn $75 to $150 for their time and opinions and no sales are involved.

JOIN, PLAY, SPEAK OUT and EARN some cash! Sign up below and don't forget to pass the word on to all of your friends!

Please Note: Filling out the following form will also add you to our regular respondent database. Only one submission is necessary.
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Assurance of Privacy


This form is divided into the following sections:

Fill out the information in each section as requested. Then at the end of the form, press the
submit button. A confirmation message will pop up after your submission is received.

SECTION A -- Personal & Household Information

Please fill out the form as completely as possible. 

  1. How did you find us / Who referred you?


    Please Specify Referral, Website, School, Organization or Employee:
     
  2. What is your name, address & phone number? 
    First Name	
Last Name 	

Street		
City  	 	
State		
Zip Code		
Country		

	      	          Ex:    415	  398-4140      
Home Phone Number  	 

Work Phone Number   	 

Cell Phone Number   	  

 From time to time, we send out advance notice of upcoming groups via text 
message. Click here if you would like to receive these notifications. Please be
 assured that we will ONLY send you information about future marketing research
 sessions with FFR.


More often, we send out advance notice of upcoming groups via email.
To facilitate this, we ask that you provide us with an email address.
Please be assured that we will only use this information to get in touch about
marketing research sessions with FFR.

Email Address	

  3. What is your birthdate? (Please be honest as it is
very important for demographic purposes.)

(Please list in this format: MM/DD/YYYY
Example: 09/09/1940 - NO PERIODS OR SPACES)



  4. What is your marital status?:
  5. What is your current living situation?
  6. Last education level completed? 



  7. What is your ethnic background?
  8. Please tell us which income range best describes your total annual household income? (Meaning everyone in your household combined.
    Your best guess is fine.)

    This information is very important for demographic purposes
    and will remain absolutely CONFIDENTIAL.
  9. Do you work full time, part time, are you a student or are you not working currently?:

    Full Time Part Time Not Working Full-Time Student 
     PT / Also a Student
  10. If employed, what is your primary occupation / job title?
  11. If employed, who is your primary employer?
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SECTION B -- Technology, Music & Gaming

 

  1. What are your favorite radio stations? List up to four in the spaces provided.
    (Please list call letters, if possible.) 

    Ex: KLLC           KITS
               

  2. Do you own a home computer or Video Game System? What type and what
    other accessories do you own?
    (Check all that apply):

     IBM or compatible Desktop
    IBM or compatible Laptop or Notebook
     Apple Macintosh or compatible Desktop
     Apple Macintosh or compatible Laptop or Notebook

     PDA (Palm, PocketPC, etc) Internet Access Cellular Phone
     Digital Camera IPod or Other Portable Music Player

     Nintendo DS Nintendo GameCube  Nintendo Wii Sony PS2 
     Sony PS3 Sony PSP   Xbox Xbox 360   PC Games
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FORM SUBMISSION

We appreciate your interest in our research groups and look forward to speaking with you.
Thanks again!


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BBB Fleischman Field Research - A Member of the Better Business Bureau  

Information, Questions or Comments? Contact us at:  respond@ffrsf.com.		  
 

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Fleischman Field Research
250 Sutter Street, 2nd Floor, San Francisco, CA 94108
Phone: (415) 398-4140 - Fax: (415) 989-4506 - Toll Free: (800) 277-3200
Email: ffr@ffrsf.com