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* 1. Contact Information

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* 2. What is your age?

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* 3. What is your DOB?

Date

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* 4. What is your gender?

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* 5. What is your ethnicity? (Select all that apply)

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* 6. Are you the female head of the household?

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* 7. What is your current employment status?

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* 8. Sometimes the type of work people do affects the products they buy. Are you, or is any member of your household employed in any of the following occupations?

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* 9. For what companies are all the working members of your household employed?

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* 10. Are you or any members of your household employed by…

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* 11. Are you currently scheduled to participate in any marketing research studies with us or any other company?

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* 12. Have you, yourself, participated in any market research survey(s) within the past 3 months?

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* 13. Which is your current marital status?

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* 14. At the present time, do you have any children aged 12 to 48 months living in the household?

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