Birmingham – Over 70’s – Refer a Friend!

Thank you for registering your interest in referring a friend in the Birmingham area.

We are looking for people who are over 70, male or female! Know anyone? Refer them to us and if we can book them in, we'll give you a £10 Amazon voucher!

NOTE: They must be NEW to our database to take part!

Details as follows:

Date – Tuesday 6th September 2016
Duration – 90 minutes
Location - Central Birmingham
Incentive - (for THEM) £45 cash
Incentive - (for YOU) £10 Amazon voucher (per referral who participates in a project)
Type of research - Group Discussion

If you do refer anyone who fits the profile of respondent that we are looking for, then one of our team will contact them directly.

Your Contact Details

First Name *

Surname *

Daytime Contact Telephone Number *

Alternative Contact Telephone Number

Email Address *

Refer a Friend

How many people would you like to refer? * 12345

Referral 1

Full Name

Daytime Contact Telephone Number

Email Address

Age Bracket Under 7071 - 7576 - 8081+I don't know

How do you know them? Family RelationFriendColleagueAcquaintOther How do you know them?

Referral 2

Full Name

Daytime Contact Telephone Number

Email Address

Age Bracket Under 7071 - 7576 - 8081+I don't know

How do you know them? Family RelationFriendColleagueAcquaintOther How do you know them?

Referral 3

Full Name

Daytime Contact Telephone Number

Email Address

Age Bracket Under 7071 - 7576 - 8081+I don't know

How do you know them? Family RelationFriendColleagueAcquaintOther How do you know them?

Referral 4

Full Name

Daytime Contact Telephone Number

Email Address

Age Bracket Under 7071 - 7576 - 8081+I don't know

How do you know them? Family RelationFriendColleagueAcquaintOther How do you know them?

Referral 5

Full Name

Daytime Contact Telephone Number

Email Address

Age Bracket Under 7071 - 7576 - 8081+I don't know

How do you know them? Family RelationFriendColleagueAcquaintOther How do you know them?

Disclaimer

This information will be held confidentially and securely by Roots Research Ltd in accordance with the Data Protection Act 1998 and Market Research Society Code of Conduct. I understand that my information will only be used to provide me with the opportunity to participate in occasional paid research. I am aware that I am under no obligation to participate and I am entitled to have my data removed at any point.

Agree

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