1.Are you a resident of:

City of Delavan

Town of Delavan

Village of Darien

Town of Darien

Other

If Other (please specify)

2.What is your Gender

Male

Female

3.What is your age range?

Under 18

18 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 and over

4.Does your household include members in the following age categories, including yourself? Select all that apply.

Under 5

Ages 5 - 10

Ages 11 - 18

Ages 19 - 25

Ages 25 - 54

55 and over