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Complete this form prior to your arrival at Shugoll Research, so we can meet your special needs.

TODAY'S DATE:
DATE AT SHUGOLL RESEARCH:
CONTACTS NAME:
MODERATOR'S NAME:
COMPANY NAME:

(Respondent grids/profiles will be provided for moderator and each client upon arrival)

FOOD
Food for respondents:  Yes   No No. of respondents:
Food for clients:  Yes   No No. of clients:
Food for moderator:  Yes   No  
Moderator should be served at AM PM.
Clients should be served at AM PM.
Please order (TYPE OF FOOD - CLICK TO SEE MENUS):
Client/Moderator:
Respondents:

AUDIO/VISUAL NEEDS:
Audio Recording:   Yes   No
  Cassette Tape
  CD
   
Digital Files: Saved to your flash drive (no charge)
  Saved to a flash drive provided by Shugoll
      Research ($30 per flash drive)
  Uploaded to Secure FTP ($50 per project)
   
Videorecording:   Yes   No
 If yes please choose type of videotaping: ½ inch/VHS
  DVD
  Stationary
  With operator
  Timecode

THE FOLLOWING WILL BE IN YOUR ROOM:
Name tags (tent type)
Flip charts, easel and markers
Push pins and tape to use on wall
Display for boards
Pads/sharpened pencils (for each respondent)

ADDITIONAL ITEMS NEEDED IN FOCUS GROUP ROOM
(PLEASE INDICATE # NEEDED)
VCR
(number: )		    TV monitor
(number: )
Overhead projector/screen
(number: )		 Computer(s)
(number: )
Other (please specify)
(number: )
Other (please specify)
(number: )
Need Internet access

DELIVERABLES:
Audiotapes, videotapes (when appropriate), screeners, sign-in sheets and other materials should be:
Given to moderator
Sent to the following address:
If sending, provide Fed Ex account number:

ANY SPECIAL INSTRUCTIONS FOR THE GROUPS: