Register me for:
Focus Groups only
Online only
Both

First Name:
Surname:

Telephone Number: () - -

Email:

Town/City:

Province/State:

Gender:
Male
Female

Age:

Marital Status:
Married/Common Law
Single
Separated/Divorced
Widowed

Do you currently smoke cigarettes?:
Yes
No

How did you find us?:

Comments/Questions:

By clicking submit, you give permission for Metroline to e-mail you from time to time with updates and invitations to participate in research.
Metroline is a marketing research company that will never try to sell you any products or services.
All personal information provided or collected from participants during the research process is protected and kept confidential, in accordance with Canadian Privacy Legislation.