What do you want, need, feel?

Moms who have taken this survey shared with us that they found it a rewarding opportunity for self reflection and inspiration. Your participation and responses are completely anonymous unless you choose to share your contact information at the end of the survey.

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* 1. What is the number one challenge you have as a mom?

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* 2. What is the number one challenge you have as a woman?

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* 3. What is the age of your child/children?

0-2 years old

3-5 years old

6-10 years old

11-13 years old

14-18 years old

18+

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* 4. If you had a magic wand, what is...

the first thing you would change in your life?

the first thing you would change in your child/children's life?

the first thing you would change in the world?

the first thing you would change in your family?

the first thing you would change in your community?

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* 5. Moms represent 85% of purchasing power in the United States. Moms are also powerful role models for their children and influential among their peers. Please RANK the following, from Most Important to Least Important, in terms of how you would like to use your influence:

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* 6. What do you want?

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* 7. What do you need?

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* 8. What do you feel?

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* 9. Check all that you are interested in:

Building my own, mom-focused company

Participating in a Momfluential R&D Board and sample free sustainably-made products

Being invited early to online and in-person Momfluential events and parties

Receiving a supportive #MomfluentialMonday text

Learning how to flex my mom power with a Momfluential Monthly newsletter

Becoming the Founder of a regional Momfluentials Meet Up group

Joining an online Momfluentials community

Receiving special offers reserved for Momfluential Community Members

Contribute personal stories and tips on being a Momfluential

Other (please specify)

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* 10. Please share Momfluentials updates and opportunities with me.

Name

ZIP/Postal Code

Country

Email Address

Phone Number to receive occasional text updates (no more than once a week)