RBS – TO APPLY RESPONDENTS

When completing the form please answer carefully and as honestly as possible, there are no right or wrong answers, all answers will be looked at individually when checking that you are applicable for the research.

If you are a good fit for the research, a member of the team will be in touch over the coming days with some more information!

Call Comments

PLEASE FILL OUT IF RECRUITED: Location / Date / Time Booked Edinburgh: Thursday 18th August - 6pm-7.30pm Blackburn: Friday 19th August - 3pm-4.30pm Worthing: Monday 22nd August - 10am-11.30am Aberdeen: Wednesday 24th August - 3.30pm-5pm Glastonbury: Wednesday 31st August - TBC Customers: TBC - 12pm-1.30pm Stakeholders: TBC - TBC

Your Contact Details

First Name *

Surname *

Daytime Contact Telephone Number *

Alternative Contact Telephone Number

Email Address *

Your Current Life Stage...

Gender * Male Female Other

Which age bracket do you fit into? * 18 - 30 31 - 40 41 - 50 51 - 60 61+

ADMIN: Please can I take your exact age?

Please tell us your ethnic background? * White Mixed / Multiple ethnic group Asian / Asian British Black / African / Caribbean / Black British Other ethnic group

What is your living status?

What is your occupation and industry? Who is the chief income earner in the household? If not them, please take the person who is occupation and industry.

Do you have children?

Yes

No

SCREENING: Current & Past Employment

SCREENING: Past Research

SCREENING: Suitability

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

Disagree

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