IBUKI Gift Campaign
Exit this survey

1. Default Section

*
1. Contact Information - Used only to contact winner and deliver Zojurushi Rice Cooker

Contact Information - Used only to contact winner and deliver Zojurushi Rice Cooker Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

*
2. What is your gender?

What is your gender? Female

Male

*
3. What is your age range?

What is your age range? Under 21

21-30

31-40

41-50

51-60

61 and over

*
4. What is the highest level of education you have completed?

What is the highest level of education you have completed? High school

Trade school

Some college

Associate degree

Bachelor's degree

Master's degree

Doctorate degree

Other

*
5. Current occupation?

Current occupation? Professional/Technical

Business Owner/Manager

Self Employed

Clerical

Sales

Student

Home Maker

Retired

Other

6. Household annual income range

Household annual income range Under $25,000

$25,000-50,000

$50,000-75,000

$75,000-100,000

$100,000-150,000

More than $150,000

*
7. Please check all that applies to you.

	Yes	No
I am Japanese citizen	*Please check all that applies to you. I am Japanese citizen Yes	I am Japanese citizen No
I am Japanese American	I am Japanese American Yes	I am Japanese American No
I have lived in Japan	I have lived in Japan Yes	I have lived in Japan No
I am learning or have learned Japanese	I am learning or have learned Japanese Yes	I am learning or have learned Japanese No
I have traveled to Japan	I have traveled to Japan Yes	I have traveled to Japan No
I plan to visit Japan	I plan to visit Japan Yes	I plan to visit Japan No

*
8. How often do you dine at Japanese restaurants?

How often do you dine at Japanese restaurants? More than three times a week

Once or twice a week

Once or twice a month

Less than once a month

*
9. How often do you cook Japanese food at home?

How often do you cook Japanese food at home? More than three times a week

Once or twice a week

Once or twice a month

Less than once a month

*
10. How many people do you share the information in IBUKI Magazine with?

How many people do you share the information in IBUKI Magazine with? 0

form {display:none;} #jserror {text-align:center;margin-top:50px;}Javascript is required for this site to function, please enable.

IBUKI Gift CampaignExit this survey

1. Default Section

*1. Contact Information - Used only to contact winner and deliver Zojurushi Rice Cooker

*2. What is your gender?

*3. What is your age range?

*4. What is the highest level of education you have completed?

*5. Current occupation?