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Thank you for your interest in participating in our focus group discussion. Please complete the following questions. We will get back to you shortly with additional details on the focus groups if you are selected to participate.

Please email rkupritz@outsourcemktng.com with any questions.

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* 1. Select all that apply:

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* 2. Which of the following applies to you/your child:

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* 3. Please select which which of the following dates/times you would be available to participate in the 90 minute focus group (select all that apply). If none of these dates/times work for you, please let us know what days/times work best for you in the "Other" box:

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* 4. Who are you registering for the focus group?

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* 5. For parents registering as participants: Please provide the following information so we can contact you with additional information on the focus group.

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* 6. For students registering as participants or parents registering their children:

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