We are collecting a database of individuals who would like to participate in 'Online Market Research'. All you have to do is fill out this form and we will contact you by email (or phone) when we are carrying out a research project.

We pay for these services as well as online expenses.

Note: Micromex Marketing Services is a division of Micromex Systems Pty Ltd and is a bona fide independent market research company. Any information supplied will only be used by Micromex and will not be passed onto any other company or person. Your name will not be used for any database marketing without your agreement.

1. Personal details