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Name

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* 1. Name

Gender

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* 2. Gender

Age

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* 3. Age

In what city do you live?

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* 6. In what city do you live?

How do you value equality vs markets?

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* 7. How do you value equality vs markets?

Equality Markets
i We adjusted the number you entered based on the slider’s scale.
How do you value the good of the nation vs the good of the world?

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* 8. How do you value the good of the nation vs the good of the world?

Nation World
i We adjusted the number you entered based on the slider’s scale.
How do you value liberty vs authority?

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* 9. How do you value liberty vs authority?

Liberty Authority
i We adjusted the number you entered based on the slider’s scale.
How do you value tradition vs progress?

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* 10. How do you value tradition vs progress?

Tradition Progress
i We adjusted the number you entered based on the slider’s scale.
How many hours would you be willing and able to do basic income advocacy activities per week?

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* 11. How many hours would you be willing and able to do basic income advocacy activities per week?

What is your job title? (Put "Human" if you are not currently employed)

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* 12. What is your job title? (Put "Human" if you are not currently employed)

Which of the following do you possess?

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* 14. Which of the following do you possess?

In what ways are you interested in helping the movement?

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* 15. In what ways are you interested in helping the movement?

What is your email address?

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* 16. What is your email address?

What is your phone number? (optional)

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* 17. What is your phone number? (optional)

Contacting you

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* 18. Contacting you

Have any questions, ideas, or feedback for us? Let us know below or just leave this blank.

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* 19. Have any questions, ideas, or feedback for us? Let us know below or just leave this blank.

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