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* 1. What is your FIRST and LAST name?

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* 2. What is the best phone number for us to contact you on?

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* 3. What is the best email address to contact you at?

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* 4. What is your gender?

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* 5. What is your age?

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* 6. What borough or town do you currently reside in?

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* 7. What is your home ZIP?

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* 8. Which of the following best describes your ethnic background?

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* 9. Which of the following best describes your marital status?

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* 10. Are you the parent of any children under currently living full time in your household?

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* 11. Are you a US citizen?

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* 12. Which of the following best describes your employment situation?

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* 13. If employed, what industry do you work in?

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* 14. If employed, what is your job title?

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