FocusJr

Name

Telephone number

Address

City

State

Zip code

Email address

What is your job title or position?

Are you:

Male
Female

What is your age?

Do you currently have any children living with you in your household?

Yes
No

If yes to children living at your home, please tell us their ages,

What is the total number of people living in your household?

Are you or is any member of your household employed by, laid off or unemployed from, or retired from any of the following types of companies?

An advertising agency
A public relations company
In the news media such as TV, radio, or newspaper
As the manager of a grocery store, supermarket, convenience store, discount store, drug store, or mass merchandiser like Walmart or Target
A market research firm or the market research department within a company
A company that manufactures, distributes or sells cosmetics
A company that manufactures, distributes or sells food and beverage products

In the past 6 months, have you participated in or are you scheduled to participate in any other marketing research projects including, but not limited to focus groups, interviews, surveys, etc.?

Yes
No

In the past 12 months, have you participated in any research studies regarding:

Oral Care
Weight Management
Food and Beverages
Pain Relief

Which of the following types of beverages have you consumed in the past 4 weeks?

Water
Sparkling Water
Milk
Juice (fruit or vegetable)
Fruit Drink
Zero Calorie Sodas
Regular Sodas
Tea
Coffee
Alcoholic Beverage
Other

And which, if any, of the following beverages would you NEVER consider drinking?

Water
Sparkling Water
Milk
Juice (fruit or vegetable)
Fruit Drink
Zero Calorie Sodas
Regular Sodas
Tea
Coffee
Alcoholic Beverage
Other

Again, we are looking for people who DO and DO NOT drink different brands of sparkling water. For each brand I read to you, please estimate how often you drink it, if at all, on an MONTHLY BASIS.

Perrier

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Poland Spring

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Gerolsteiner

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Topo Chico

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Crystal Geyser

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Badoit

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Mountain Valley Spring Water

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Talking Rain

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Schwepps

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Saratoga Springs

0 times a month
1x a month
2x a month
3 or more times a month
never drink

Please tell us what is your favorite sparkling water (For those that do not drink sparkling water say "None".)

Which of the following best describes your ethnic background?

Caucasian
African-American
Asian
Native American
Hispanic/Latino
Bi-racial

What is the highest level of education you have completed?

Less than high school
High school graduate
Some College or Technical School
Graduate of a 2 - year college
Graduate of a 4 - year college
Masters Degree
Ph.D.

Which of the following best describes your school/working situation, are you…?

Full-Time Student
Employed Full-Time
Employed Part-Time
Work From the Homeea
Stay-at-Home Parent
Unemployed

Which of the following best describes your total annual household income before taxes?

Under $20,000
$20,000 – $30,000
$30,000 – $40,000
$40,000 – $50,000
$50,000 – $65,000
$65,000 - $80,000
$80,000 - $100,000 or more
$100,000 or more

For my last question, I’d like for you to use your imagination. There are no wrong answers to this question! If your life became a color, what color would it be and why?

Submit Your Responses