Insight Space | Join Our Database

Insight Space is a market research firm with offices in Seattle and San Diego. We organize and facilitate focus groups, product evaluations, usability testing, and a variety of product research projects. If you are interested in participating, please complete this form. The more information you provide, the greater the likelihood that you will be called/emailed by our staff for a research study.

NOTE: WE DO ASK THAT EACH MEMBER OF THE HOUSEHOLD, WHO IS AGE 18 OR OLDER, FILL OUT THEIR OWN FORM.

Referral Information

How did you learn about the Panel?

Name of person who referred you:

Contact Information

Name

Home Address

My primary contact number is a:

Mobile Phone

I hereby grant you permission to contact me by SMS / Text Messaging to match me to paid opportunities to give my opinion.

Home Phone

Work Phone

Demographic Information

Date of Birth

Gender

Ethnicity

Marital Status

Housing

Highest Level of Education

Household Income

Pets

Dog Cat Other

Electronic Devices

Apple iPhone Android Phone iPad/Tablet E-reader TV Streamer Sirius XM Radio

Personal Computer (Laptop or Desktop)

Mac Windows PC

Gaming

Nintendo Sony Microsoft Xbox Kinnect PC games on CD PC games online Trading card games Other

Employment

Employment Status

Job Title

Employer

Industry

Number of Employees (worldwide)

Children (we sometimes need the opinions of parents or children)

Number of children living in the home under the age of 21

Name of Child 1

Gender

Date of Birth

Name of Child 2

Gender

Date of Birth

Name of Child 3

Gender

Date of Birth

Name of Child 4

Gender

Date of Birth

Name of Child 5

Gender

Date of Birth

Name of Child 6

Gender

Date of Birth

Participation Agreement

Permission to Contact

I hereby grant you permission to contact me by phone, email, or postal mail to verify my information or about match me to paid opportunities to give my opinion.

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Referral Information

Contact Information

Demographic Information

Employment

Participation Agreement