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1. Islam Channel Survey - Page 1 of 2
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1
. Assalaamu'alaikum wa rahmatullahi wa barakaatuhu.
Please provide a little information about yourself. All information is strictly confidential and will NOT be disclosed to third parties; it is solely for the use of Islam Channel.
Assalaamu'alaikum wa rahmatullahi wa barakaatuhu. Please provide a little information about yourself. All information is strictly confidential and will NOT be disclosed to third parties; it is solely for the use of Islam Channel.
First Name:
Surname:
Home City/Town:
Country of Residence:
Valid Email Address:
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2
. Gender
Gender
Male
Female
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3
. Age
Age
Under 18
18-25
26-35
36-44
45-55
56-65
Over 65
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4
. Marital Status
Marital Status
Married
Not married
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5
. Employment Status
Employment Status
Employed
Self-employed
Out of work
A homemaker
A student
Retired
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