Registration

Our Lenox Square Mall Office

Address:

MacConnell Research Services
3393 Peachtree Rd
Suite 2038E
Atlanta, GA 30326
Lenox Square Mall is a premier destination mall located in the heart of Buckhead, Atlanta. The J.W. Marriott is located adjacent to the mall. Hertz car rental has an office in the hotel. Our facility is easily accessed by MARTA from the Atlanta Airport.

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Contact Us

For bid information or other client related need please contact:

Terri Clark
Phone: 770-309-8917

Email: tclark@macconnellresearch.com

If not avaible please contact phone number below and corporate email address below.

For general questions and inquiries:

Phone: 404-846-0005

Fax: 404-846-0009

Email: corporate@macconnellresearch.com

Personal Information

First Name:*

Last Name:*

Address1:*

Address2:

City:*

State:*

Zip Code:*

County:*

Home Phone:*

Work Phone:

Cell Phone:

Email Address:*

Gender:* Male Female

Date of Birth
(mm/dd/yyyy):*

Ethnicity:

Marital Status:*

Education:*

Profession:*

Household and Vehicle Information

Household Income
(enter numbers only): .00 per year.

Do you own your home?* Yes No

Do you own any vehicles?* Yes No

If 'Yes', please list:

Vehicle 1 Make:

Vehicle 1 Model:

Vehicle 1 Year:

Vehicle 2 Make:

Vehicle 2 Model:

Vehicle 2 Year:

Vehicle 3 Make:

Vehicle 3 Model:

Vehicle 3 Year:

Medical Information

Are you a diabetic? Yes No

If 'Yes', what stage?

Are you taking any medications?* Yes No

If 'Yes', please list:

Hobbies

Do you have
any hobbies?* Yes No

If 'Yes', please list:

Perfumes

Do you wear
any perfumes?* Yes No

If 'Yes', which brands:

Pets

Do you own a
dog or cat?* Yes No

If 'Yes', which brands of dog or cat food do you buy

Please type the characters you see in the image

Registration

Our Lenox Square Mall Office

Personal Information

Household and Vehicle Information

Medical Information

Hobbies

Perfumes

Pets

Children

Tobacco and Alcohol

David Ottenfeld

Tammy Ciliberti

MacConnell Research working in Hartsfield-Jackson Airport.

Looking forward to a great year!!!!!

Welcome Cooler Temperatures