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A focus group is an informal gathering of people to share opinions on products and services. Your opinion can make a difference. In addition, those who participate in groups receive a cash honorarium. We need information so we can call you for the appropriate group.
Trotta Associates will never attempt to sell you anything; we are only interested in your opinions.  Your privacy is important to us and we will never sell or share your personal information with any third parties.  We store personal information in a secure, encrypted computer system.  Registration information is obtained by your consent via our web site, written submission, or contact with our staff of professionals.  We look forward to hearing from you!

Already in our database? E-mail your new and old information database@trotta.net
New to our database ? Please submit the following form or call us at (310)306-6866.

First Name

Last Name

Address

City

Zip Code

-

Home Phone

( ) -

Work Phone

( ) - ext

Cell Phone

( ) -
Email

Date of Birth

Month     Day

Year

Gender (list)

Marital Status (list)

Ethnic Background (list)

Mixed Ethnicity

Highest Level of Education (list)

Employment Status (list)

Local Employees
World Wide Employees
Occupation


Physician – If so, specialty:



Title
Company
Industry
Housing Type

Total household Income (list)

Automobiles in Household

Automobile #1

Year Make Model

Automobile #2 Year Make Model
Automobile #3 Year Make Model
Automobile #4 Year Make Model
Other members of your household
Name Gender Date of Birth

Month    Day

Year

Ethnicity

Month     Day

Year

Ethnicity

Month     Day

Year

Ethnicity

Month     Day

Year

Ethnicity

Month     Day

Year

Ethnicity

How did you hear about us?
Options

Other:

Referred by

 

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Trotta Associates - Two Los Angeles area Focus Group Facilities
Culver City and Irvine, California
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