Arthritis Foundation Participant Survey Please complete all sections. Question Title * 1. Please select the Arthritis Foundation Program you participate in: Exercise Program (land) Aquatics Program (water) Question Title * 2. Is this your first time taking an Arthritis Foundation Exercise Program class? Yes No Question Title * 3. What is your gender? Female Male Question Title * 4. In what year were you born? (enter 4-digit birth year; for example, 1976) Question Title * 5. What is your City? Question Title * 6. What is your State? Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Question Title * 7. What is your ethnic background? Native American Asian American African American Hispanic or Latino White / Caucasian Question Title * 8. Do you have arthritis? Yes No Next