Facility Services | Galloway Research Service

Name

First Last

Email

Company Name

Project Name

What name would you like on the Moderator's tent card?

How many viewers do you expect to attend the sessions?

What time do you expect viewers to begin arriving?

Would you like any of the following trays available upon your arrival? (optional)

Vegetable Tray
Fruit Tray
Cheese Tray
Fruit & Cheese Tray
Vegetable and Cheese Tray

Do you have any additional food needs or would you like to order off menus?

We serve all respondents sandwich trays during meal time sessions. All other times snacks and soft drinks will be available. Do you have any other requests for respondent meals/snacks?

Which of the following Recording options would you like?

Digital Audio Mp3 Downloads ($25/Hour)
DVD Video Recording ($100/Hour)
Digital Video Downloads ($75/Hour, $400 Max Per Day/Room) Recorded at

What email addresses would you like your digital recordings sent to?

Would you like a respondent living room setup for your sessions?

Yes
No

Do you have any additional onsite technical needs?

Will we be receiving any shipments prior to your sessions? ie: product needs to be refrigerated or storage space is needed If so are are there any special instructions to be followed after shipment has arrived?

Do you have any additional request or needs for your sessions?

Attachments?

Max. file size: 8 MB.