If you are interested in holding a focus group for your company or organization at Boulder Focus Center please fill out the following form as completely as possible and we will get in touch with you promptly.


Contact information

Your name:  
Contact Title *first name(s) *last name/surname
Department Company/Organization Name

Address:		  

Address line 2:		  
   

City:
*State/International:

*Zip code:

(If international) Country:

*Please provide a phone number, fax number OR email address so that we may contact you about your request.

Phone:		  
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Fax:		  
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Email address:		  



Fill in the fields you need to explain your requirements:

Specifications:

Project Name:  
Focus Group Dates:  
Facility Times / Length:  
Number of Participants:  
Number of Clients:  


Facility Requirements:

Food for respondents: Food for clients:
Moderator: Transcripts:
Teleconferencing: Videotaping:
Report:    

Other Facility Requirements:


Screening Specifications:

Ages: Genders:
Race: Income:
Incidence in population:    

Proposed Incentive:
Other Screening Criteria:
Anything else?
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Boulder Focus Center, Boulder, CO
Phone: 303-449-6558 ext.2101  ·  Fax: 303-449-6587  ·  Email: info@boulderfocuscenter.com
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