2010 We Love This Country VIP Club Travel and Purchase Intentions Survey

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1. To be eligble to win a prize, please provide the following details:

To be eligble to win a prize, please provide the following details:   Name:
Address:
Address 2:
City/Town:
State:
Postal Code:
Email Address:
Phone Number:

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2. Age Bracket (years):

< 1516 - 2122 - 3031 - 4041 - 5051 - 6061 - 7071 - 8080 +

Age Bracket (years):

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3. Gender:

MaleFemale

Gender:

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4. Marital Status:

SingleMarried/DefactoSeperated/DivorcedWidowed

Marital Status:

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5. Number of dependent children:

01234+

Number of dependent children:

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6. Your permanent home is:

Traditional HouseApartment/FlatTownhouse/UnitRelocatable HomeCaravan/MotorhomeNone - Transient

Your permanent home is:

Other (please specify)

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7. Current working status:

Current working status:   Working Full Time Working Part Time Retired Student Home Duties Not Working

8. If you are currently working, what is your occupation?

Blue Collar/GeneralWhite Collar/OfficeQualified TradespersonProfessional VolunteerUnpaid Worker

If you are currently working, what is your occupation?

Other (please specify)