Brainsights Events Registration Questionnaire: Mumbai

Please complete the following questions, to the best of your ability.

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Phone Number:

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* 5. Address:

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* 6. Date of Birth (MM/DD/YYYY)

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* 7. Gender

Male

Female

Would prefer to specify

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* 8. Ethnicity

African

White/Caucasian

Black

Filipino

Arab

Latin, Central or South American

Japanese

Korean

Chinese

Vietnamese

West Asian (Afghan, Iranian, etc.)

East Asian (Cambodian, Malaysian, Indonesian, etc.)

South Asian (East Indian, Pakistani, etc.)

Indian

West Indian (Caribbean Islander)

Prefer not to answer

Other (please specify)

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* 9. Birthplace (City, Country)

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* 10. I have children in the following age ranges (select all that apply):

No Children

Currently Expecting

Newborn - 4 years

5 - 7 years

8 - 11 years

12 - 16 years

17+ years

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* 11. Do you own a car?

Yes

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* 12. If you own a car, please enter the make/model of any cars you own. If you don't own a car, please enter NA.

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* 13. Have you purchased a car in the last 12 months?

Yes

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* 14. Do you intend to purchase a car in the next 12 months?

Yes

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* 15. What is your gross annual household income?

Less than 500,000 rupees

500,000 - 800,000 rupees

More than 800,000 rupees

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* 16. Which best describes your employment?

Student

Unemployed / Looking for work

Part time

Full time

Homemaker / Stay at home parent

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* 17. What is your impression of the following brands?

	1 - Strongly dislike	2 - Dislike	3 - Somewhat dislike	4 - Neutral or no opinion	5 - Somewhat like	6 - Like	7 - Strongly like	I've never heard of this brand
Maruti Suzuki	Maruti Suzuki 1 - Strongly dislike	Maruti Suzuki 2 - Dislike	Maruti Suzuki 3 - Somewhat dislike	Maruti Suzuki 4 - Neutral or no opinion	Maruti Suzuki 5 - Somewhat like	Maruti Suzuki 6 - Like	Maruti Suzuki 7 - Strongly like	Maruti Suzuki I've never heard of this brand
Hyundai	Hyundai 1 - Strongly dislike	Hyundai 2 - Dislike	Hyundai 3 - Somewhat dislike	Hyundai 4 - Neutral or no opinion	Hyundai 5 - Somewhat like	Hyundai 6 - Like	Hyundai 7 - Strongly like	Hyundai I've never heard of this brand
Mahindra	Mahindra 1 - Strongly dislike	Mahindra 2 - Dislike	Mahindra 3 - Somewhat dislike	Mahindra 4 - Neutral or no opinion	Mahindra 5 - Somewhat like	Mahindra 6 - Like	Mahindra 7 - Strongly like	Mahindra I've never heard of this brand
Toyota	Toyota 1 - Strongly dislike	Toyota 2 - Dislike	Toyota 3 - Somewhat dislike	Toyota 4 - Neutral or no opinion	Toyota 5 - Somewhat like	Toyota 6 - Like	Toyota 7 - Strongly like	Toyota I've never heard of this brand
Tata	Tata 1 - Strongly dislike	Tata 2 - Dislike	Tata 3 - Somewhat dislike	Tata 4 - Neutral or no opinion	Tata 5 - Somewhat like	Tata 6 - Like	Tata 7 - Strongly like	Tata I've never heard of this brand
Renault	Renault 1 - Strongly dislike	Renault 2 - Dislike	Renault 3 - Somewhat dislike	Renault 4 - Neutral or no opinion	Renault 5 - Somewhat like	Renault 6 - Like	Renault 7 - Strongly like	Renault I've never heard of this brand
Honda	Honda 1 - Strongly dislike	Honda 2 - Dislike	Honda 3 - Somewhat dislike	Honda 4 - Neutral or no opinion	Honda 5 - Somewhat like	Honda 6 - Like	Honda 7 - Strongly like	Honda I've never heard of this brand
Ford	Ford 1 - Strongly dislike	Ford 2 - Dislike	Ford 3 - Somewhat dislike	Ford 4 - Neutral or no opinion	Ford 5 - Somewhat like	Ford 6 - Like	Ford 7 - Strongly like	Ford I've never heard of this brand
Datsun	Datsun 1 - Strongly dislike	Datsun 2 - Dislike	Datsun 3 - Somewhat dislike	Datsun 4 - Neutral or no opinion	Datsun 5 - Somewhat like	Datsun 6 - Like	Datsun 7 - Strongly like	Datsun I've never heard of this brand
Volkswagen	Volkswagen 1 - Strongly dislike	Volkswagen 2 - Dislike	Volkswagen 3 - Somewhat dislike	Volkswagen 4 - Neutral or no opinion	Volkswagen 5 - Somewhat like	Volkswagen 6 - Like	Volkswagen 7 - Strongly like	Volkswagen I've never heard of this brand

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* 18. Would you consider purchasing any of the following brands in the future?

	1 - Definitely would not consider	2 - Probably would not consider	3 - Not sure	4 - Might consider	5 - Definitely would consider
Maruti Suzuki	Maruti Suzuki 1 - Definitely would not consider	Maruti Suzuki 2 - Probably would not consider	Maruti Suzuki 3 - Not sure	Maruti Suzuki 4 - Might consider	Maruti Suzuki 5 - Definitely would consider
Hyundai	Hyundai 1 - Definitely would not consider	Hyundai 2 - Probably would not consider	Hyundai 3 - Not sure	Hyundai 4 - Might consider	Hyundai 5 - Definitely would consider
Mahindra	Mahindra 1 - Definitely would not consider	Mahindra 2 - Probably would not consider	Mahindra 3 - Not sure	Mahindra 4 - Might consider	Mahindra 5 - Definitely would consider
Toyota	Toyota 1 - Definitely would not consider	Toyota 2 - Probably would not consider	Toyota 3 - Not sure	Toyota 4 - Might consider	Toyota 5 - Definitely would consider
Tata	Tata 1 - Definitely would not consider	Tata 2 - Probably would not consider	Tata 3 - Not sure	Tata 4 - Might consider	Tata 5 - Definitely would consider
Renault	Renault 1 - Definitely would not consider	Renault 2 - Probably would not consider	Renault 3 - Not sure	Renault 4 - Might consider	Renault 5 - Definitely would consider
Honda	Honda 1 - Definitely would not consider	Honda 2 - Probably would not consider	Honda 3 - Not sure	Honda 4 - Might consider	Honda 5 - Definitely would consider
Ford	Ford 1 - Definitely would not consider	Ford 2 - Probably would not consider	Ford 3 - Not sure	Ford 4 - Might consider	Ford 5 - Definitely would consider
Datsun	Datsun 1 - Definitely would not consider	Datsun 2 - Probably would not consider	Datsun 3 - Not sure	Datsun 4 - Might consider	Datsun 5 - Definitely would consider
Volkswagen	Volkswagen 1 - Definitely would not consider	Volkswagen 2 - Probably would not consider	Volkswagen 3 - Not sure	Volkswagen 4 - Might consider	Volkswagen 5 - Definitely would consider

Other (please specify)

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* 19. How well do each of the following statements align with you as a person?

	1 - Strongly disagree	2 - Somewhat disagree	3 - Neither agree nor disagree	4 - Somewhat agree	5 - Strongly agree
I consider myself to be environmentally responsible/conscious	I consider myself to be environmentally responsible/conscious 1 - Strongly disagree	I consider myself to be environmentally responsible/conscious 2 - Somewhat disagree	I consider myself to be environmentally responsible/conscious 3 - Neither agree nor disagree	I consider myself to be environmentally responsible/conscious 4 - Somewhat agree	I consider myself to be environmentally responsible/conscious 5 - Strongly agree
I live life to the fullest	I live life to the fullest 1 - Strongly disagree	I live life to the fullest 2 - Somewhat disagree	I live life to the fullest 3 - Neither agree nor disagree	I live life to the fullest 4 - Somewhat agree	I live life to the fullest 5 - Strongly agree
I like to eat healthy and take care of myself	I like to eat healthy and take care of myself 1 - Strongly disagree	I like to eat healthy and take care of myself 2 - Somewhat disagree	I like to eat healthy and take care of myself 3 - Neither agree nor disagree	I like to eat healthy and take care of myself 4 - Somewhat agree	I like to eat healthy and take care of myself 5 - Strongly agree
I often think about the feelings and needs of others	I often think about the feelings and needs of others 1 - Strongly disagree	I often think about the feelings and needs of others 2 - Somewhat disagree	I often think about the feelings and needs of others 3 - Neither agree nor disagree	I often think about the feelings and needs of others 4 - Somewhat agree	I often think about the feelings and needs of others 5 - Strongly agree
I rarely go out with friends, and it doesn't bother me	I rarely go out with friends, and it doesn't bother me 1 - Strongly disagree	I rarely go out with friends, and it doesn't bother me 2 - Somewhat disagree	I rarely go out with friends, and it doesn't bother me 3 - Neither agree nor disagree	I rarely go out with friends, and it doesn't bother me 4 - Somewhat agree	I rarely go out with friends, and it doesn't bother me 5 - Strongly agree
I rarely consider the impact of my choices on the environment	I rarely consider the impact of my choices on the environment 1 - Strongly disagree	I rarely consider the impact of my choices on the environment 2 - Somewhat disagree	I rarely consider the impact of my choices on the environment 3 - Neither agree nor disagree	I rarely consider the impact of my choices on the environment 4 - Somewhat agree	I rarely consider the impact of my choices on the environment 5 - Strongly agree
I'm the last person that would organize an event with friends or my community	I'm the last person that would organize an event with friends or my community 1 - Strongly disagree	I'm the last person that would organize an event with friends or my community 2 - Somewhat disagree	I'm the last person that would organize an event with friends or my community 3 - Neither agree nor disagree	I'm the last person that would organize an event with friends or my community 4 - Somewhat agree	I'm the last person that would organize an event with friends or my community 5 - Strongly agree
I try to make lifestyle choices that are socially responsible and respect the environment	I try to make lifestyle choices that are socially responsible and respect the environment 1 - Strongly disagree	I try to make lifestyle choices that are socially responsible and respect the environment 2 - Somewhat disagree	I try to make lifestyle choices that are socially responsible and respect the environment 3 - Neither agree nor disagree	I try to make lifestyle choices that are socially responsible and respect the environment 4 - Somewhat agree	I try to make lifestyle choices that are socially responsible and respect the environment 5 - Strongly agree

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