ES Research

Complete the information below to receive weekly (approx) emails regarding all of our research projects. By telling us a bit about yourself we will be able to see when we have something we feel you are suitable for and we will also contact you directly about this when we feel there is an opportunity to take part. If you would prefer to only be contacted when we think there is something relevant rather than all research please check the box at the end of this form.

Your information will remain confidential, you will not be sold to or contacted about anything other than paid for market research by anyone other than ES Research

* indicates required

Email Address *

Name *

Mobile Number

Age

Date Of Birth

Postcode

Gender

Male
Female
Other

Lifestage

Live with parents
Live alone
Live with friends/partner
Married / cohab with no children at home
Married / cohab with children at home
Married / cohab children have left home

Do you have children

No
Yes, I have children age 0 – 10 living at home
Yes, I have children age 11 – 18 living at home
Yes, I have children age 19+ living at home
Yes, but they don't live at home anymore

Highest level of education

GCSE/Standard Grade
A Levels (or equivalent)
Certificate of diploma
Vocational qualification
Undergraduate Degree (Bachelor's)
Posgraduate Degree (Masters/Doctorate)

Job title / occupation

Please tell us about your role/responsibilities

MAKE of 1st household car (your car)

MODEL of 1st household car (your car)

Year of registration (your car)

MAKE of 2nd car in household

MODEL of 2nd car in household

Year of registration of 2nd car

What phone deal are you on

Contract
Sim only contract
Pay as you go
Other

Who provides your home broadband

Long term medical conditions? Medication taken?

Please state including details of medication taken instead of any long term medical conditions
Please state including details of any medication taken

Please tell us about any hobbies / interests etc

Have you taken part in market research before

No, never
Yes, within the last 3 months
Yes, within the last 6 months
Yes, within the last 12 months
Yes, more than 12 months ago

What was the topic of your last market research

How would you like to hear about research projects

Please send me weekly (approx) emails with all the current research projects
Please only contact me when you think the research is relevant to me based on the answers provided, e.g the car I drive, my occupation, my network provider etc
Both - Please send weekly research and contact me directly when you think there is something specific I might be suitable for

How did you hear about us?

If it was through a friend please can you tell us their full name