Create Account - Moderator
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( All fields are required )
1. Contact Information
First Name:
Last Name:
Title:
Company:
Address:
City:
State/Province:
Zip Code:
Country:
Phone:
Fax:
2. Your Position
Independent moderator
Researcher at research company (does not own any focus facilities)
Researcher at client company or agency
Field service manager/coordinator
Other, please specify
3. Focus Groups
Number of focus groups you moderate in a year:
Number of focus groups you are involved with but don't moderate in a year:
4. Certification (required)
I certify that I am not employed by nor do I have a financial interest in any firm that owns or operates focus group facilities.
I am employed by or have a financial interest in a firm that owns or operates focus group facilities.
5. User Name and Password
(Your email will be your username)
Email:
(Password must be 4 - 15 characters in length)
Password:
Confirm Password:
