HOUSEHOLD INFORMATION ADULT INFORMATION Question Title Question Title * 1. WHAT IS THE TOTAL NUMBER OF PEOPLE IN YOUR GROUP ATTENDING TODAY'S EVENT?(CHILDREN AND ADULTS) Question Title * 2. PLEASE PROVIDE THE NAME ,DATE OF BIRTH AND EMAIL ADDRESS FOR ALL ADULTS IN ATTENDANCE. NAME DOB: EMAIL Question Title * 3. WHAT IS THE TOTAL NUMBER OF PEOPLE LIVING IN YOUR HOUSEHOLD? Question Title * 4. HOUSEHOLD INCOME? 0-9999$ $10,000-$14,999 $15,000-$19,999 $20,000-$29,999 $30,000-$49,999 $50,000-UP Question Title * 5. WHAT IS THE GENDER OF THE HEAD OF HOUSEHOLD? FEMALE MALE Question Title * 6. ETHNICITY OF HEAD OF HOUSEHOLD HISPANIC NON-HISPANIC Question Title * 7. IS THE HEAD OF HOUSEHOLD AGE 62 OR OLDER? YES NO Question Title Done