Gripped Magazine

Tell us about yourself...

Question Title

* 1. Please provide your name & email address(... in case you win!)

Name

Email Address

Question Title

* 2. What is your household income?

Under $35,000

$35,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$124,999

$125,000-$149,999

$150,000-$174,999

$175,000-$199,999

$200,000 and up

Prefer not to specify

Question Title

* 3. What is your age?

Under 18

18-29

30-39

40-49

50-59

60-69

70-79

79+

Question Title

* 4. What is your gender?

Female

Male

Transgender

Prefer not to say

Other (please specify)

Question Title

* 5. What province/territory do you live in?

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

Atlantic Canada

Northwest Territories

Yukon

Nunavut

Question Title

* 6. Do you live in an urban or rural area?

Urban

Rural

Question Title

* 7. What is your Marital Status?

Single

Married

Common Law