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Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

*3.Where in the country do you live?(Required.)

Southern CA

Northern CA

West outside of CA

Illinois

Midwest outside of Illinois

South

East

Northeast

4.What state do you live in?

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Alaska

Arizona

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5.What gender do you identify as?

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Other (please specify)

6.What age range do you fall into?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

7.What is your exact age?

8.What is your current employment status? Are you…

Employed full-time (30+ hours per week)

Employed part-time (Less than 30 hours per week)

Freelance, gig or contract worker

Self-employed full or part-time

Student (full or part-time)

Full-time wife/husband or parent

Retired

Currently unemployed

Other (please specify)

9.In which of the following industries, if any, are you, yourself, currently employed?

Agriculture

Construction

Mining

Trucking / Truck transportation

Accommodation (Travel/Hoteling/Hospitality)

Architecture / Engineering

Arts / Entertainment / Recreation

Professional Services (e.g. accounting, consulting, legal, real estate)

Financial services (e.g. banking and insurance)

Food services corporate offices (not restaurants or food preparation)

Market Research

Media / Marketing / Advertising

Technology

Retail corporate offices (not physical stores)

Education

Government (National, state and local) / Public Administration

Healthcare corporate offices (not healthcare practitioners or hospitals)

Manufacturing

Telecommunications

Forestry, Fishing and Hunting

Utilities and Power

Wholesale trade

Other (please specify)

None of the above