* 1. First Name

* 2. Last Name

* 3. Email Address

* 4. Phone Number

* 6. What is your zip code?

* 7. What is your gender?

* 9. What is the highest level of school you have completed or the highest degree you have received?

* 10. Which of the following categories best describes your employment status?

* 11. Do you work in any of the following industries?

* 12. What is your job title?

* 13. How much total combined money did all members of your HOUSEHOLD earn last year?

* 14. Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group?

* 15. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

* 16. Do you rent or own the place you live in?

* 17. Which of the following best describes your current relationship status?

* 18. How many children are you parent or guardian for and live in your household (aged 17 or younger only)?

* 19. Which of the following items do you own?

* 20. Do you own any pets?

* 22. Do you consume any of the following?

* 23. Do you smoke cigarettes?

* 25. Would you like to be contacted for future (paid) market research opportunites?

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