Kahnawà:ke Gambling Survey Online Request

Question Title

* 1. Please enter your information to request the Kahnawà:ke Gambling Survey.

Why do we ask for your phone number? In case we have trouble reaching you by email, we will use your phone number to get in touch so you can still take the survey.
Why do we ask for your P.O. Box/ Mailing Address? If you need your Shop Kahnawà:ke dollars to be mailed, we can send it to you.

Last Name, First Name

Email Address

Phone Number

Mailing Address/ P.O. Box

Question Title

* 2. Preferred method to take the survey

I'd like to take the survey online and self-administer the questions. (We will follow up if we notice your survey has been left incomplete for more than 3 days)

I'd like someone to do the survey with me over the phone.

I'd like someone to do the survey with me over Zoom/ Video Chat.

I'd like someone to come to my home/ place of work and administer the questionnaire to me.

Other (please specify)