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Fresh Air Eastern Texas
1.
Since living in Eastern Texas, do you think the air quality has gotten...
Worse
Better
Same
*
2.
Does anyone in your family suffer from allergies, asthma or breathing difficulties?
(Required.)
3.
Do you have children or pets?
Children
Pets
Both
4.
Are you married or have a live in partner?
Yes
No
5.
What is your occupation?
6.
What is your spouse or partner's occupation?
7.
What is your age?
18-21
22-29
30-39
40-49
50-60
60+
8.
Do you own or rent?
Own
Rent
9.
Contact information (we will contact you by phone or text)
Name
Address
City/Town
State
Zip code
Email
Phone number
10.
Who sent you this or who's Facebook page did you click on? (First and Last Name)