What year were you born? --- 1935 or earlier 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Please select a valid item

What is your marital status? --- Married Divorced Never Married Widowed Refused Please select a valid item

What is your approximate total annual household income before taxes ($US)? --- Less than $30,000 $30,000 to 44,999 $45,000 to $59,999 $60,000 to $79,999 $80,000 to $99,999 $100,000 to $124,999 $125,000 or more Refused Please a valid item.Please select a valid item

What was the last year of school you completed? --- Some high school or less High school graduate Some college/associate degree Vo-tech graduate College graduate Some post graduate work Post graduate degree Refuse to answer Please select a valid item

Including yourself, what is the total number of members living in your household? --- 1 2 3 4 5 6 7 or more Please select a valid item

Are there any children under 18 living in your household? --- Yes No Refuse to answer Please select a valid item

Which of the following best describes your current employment? --- Proprietor/Business owner Business executive/director Middle manager Professional (Lawyer/CPA) Medical Doctor Engineer/computer programmer Police/Postal/Armed Service Skilled professional (Nurse/Paralegal) Factory Worker/Truck Driver/Equipment Operator Educator, Journalist Researcher Salesperson Farmer, Rancher, Fisherman Office/Administrative Skilled trade (plumber, electrician, etc.) Entertainer, artist Homemaker Not employed Student Retired Other Refused Please select a valid item

If employed, which of the following best describes your area of focus? --- Executive Management Finance/Acct. Human Resources IT, MIS Operations Manufacturing Shipping/Receiving Administration Health Services Web/Internet Sales/Marketing/PR Research Other Please select a valid item

If employed, which of the following best describes the company size? --- 1 - 4 employees 5 to 9 employees 10 to 19 employees 20 to 49 employees 50 to 99 employees 100 to 249 employees 250 to 499 employees 500 to 999 employees 1000 or more employees Unknown Please select a valid item

If employed, which of the following best describes the industry your company is involved in? --- Agriculture, forestry or fishing Mining Construction Manufacturing Transportation, communications or utilities Wholesale trade Retail trade Finance, insurance or real estate Services Public administration Please select a valid item

Gender --- Male Female Please select a valid item.

In what country do you live? Africa (other) Africa (South) Australia Austria Belgium Bermuda Canada China Cuba Denmark Eastern Europe Egypt France Germany Greece India Israel Italy Japan Korea Mexico Middle Eastern Countries Monaco Netherlands New Zealand Norway Other Philippines Portugal Puerto Rico Russia South American Counties Sweden Switzerland Taiwan Thailand United Kingdom United States Virgin Islands Please select a valid item

Do you own or rent your home? --- Own Rent Please select a valid item.

Which of the following would best describe your ethnicity? AfroAmerican/Black Asian Hispanic Native American Other White/caucasian Refused Please select a valid item

Which of the following languages do you speak fluently?
English Spanish French German Others

For any children under 18 living in the household, please indicate the year they were born and their gender:

	Gender	Year born
Child 1	Male Female
Child 2	Male Female
Child 3	Male Female
Child 4	Male Female
Child 5	Male Female

To what extent do you agree with each of the following statements?

1 = Strongly agree 2 = Somewhat agree 3 = Neither agree nor disagree 4 = Somewhat disagree 5 = Strongly disagree
	1	2	3	4	5
I'm typically the first or second person I know to try new things; I consider myself a real independent thinker and experimental
I am frequently the one doing the newest thing(s) first
When I have a great or an awful experience with a new brand, product, service, vendor, venue, anything, I tell lots of other people
I am often consulted by my peers for counsel and recommendation on a range of topics (e.g., vacation destinations, restaurants, movies)
I trust what I read in newspapers and magazines, and believe what I hear on television and radio
I consider myself far behind the times and not very engaged in either consumerism or pop culture.

For which of the following categories do you consider yourself highly knowledgeable? ( Please check all that apply)

	Automotive		Sports (participation)
	Cooking/entertaining at home		Sports (as spectator/fan)
	Dining out		Popular culture
	PC's and other computer equipment		Personal finance
	Mobile communications products		Health and medical
	Consumer electronics (TV, audio, etc.)		Do it yourself home projects
	Home furnishing and decorating		Fitness and Exercise
	Entertainment (movies, television, live music, etc)		Film
	Travel		Theatrical and cultural events
	Fashion and style		Television
	Parenting

Do you suffer from any of the following conditions: (Please check all that apply)

	Allergies
	Arthritis
	Asthma
	Frequent bladder urges and/or leakage
	Cancer
	Depression
	Diabetes
	Heartburn
	Heart problems
	Hypertension
	Migraines
	STD
	Stomach problems

Does anyone in your household suffer from any of the following conditions: (Please check all that apply)

	Allergies
	Arthritis
	Asthma
	Frequent bladder urges and/or leakage
	Cancer
	Depression
	Diabetes
	Heartburn
	Heart problems
	Hypertension
	Migraines
	STD
	Stomach problems

Are there any pets in your household? (Please check all that apply)

	Cat(s)
	Dog(s)
	Fish
	Small domestics (mice, rats, hamsters, guinea pigs, etc.)
	Horses
	Other
	None

Which of the following do you participate in? (Please check all that apply)

	Running/jogging
	Cycling
	Swimming
	Gym classes and workouts (member of a gym)
	Tennis
	Other racket sports
	Surfing
	Scuba diving

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