Portland FCT 2013 Participation Survey
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Futurescape City Tours Application

 
Please take 5 minutes to fill out the following application to volunteer to participate.

As science and technology progress, your voice is important in shaping new developments. Participation in the Futurescape City Tours lets you:
● Experience nanotechnology through a guided walking tour of the city.
● Talk with scientists and engineers.
● Photograph the past, present, and future of the city.
● Share your opinions about desirable futures.

Participation involves attending three gatherings:
● Thursday, October 3 (5:00-8:00PM)
● Saturday, October 26 (all day)
● Tuesday, October 29 (5:00-8:00PM)

You are not required to answer all of these questions in order to be selected to participate. This survey helps us both to know who is interested in participating and to ensure the inclusion of a diversity of perspectives. We will not share your personal data.

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1. What is your name?
2. What is the best way to contact you?
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3. What is the email, telephone, or address at which you prefer to be contacted?
4. What is your age?
5. You are ________
6. What is your ethnic affiliation?
7. What is your household income per year?
8. What is your level of formal education?
9. What is your current employment status?
10. What is your profession?
11. Do you work with nanotechnology in your profession?
12. How familiar are you with nanotechnology?
13. What are your main hobbies?
14. How would you describe your current political orientation?
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