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  2. 2011
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* What is your gender?
 
Male
 
Female
 
 
 
* Into which age range do you fall?
 
18-24
 
25-34
 
35-44
 
45-54
 
55-65
 
65 or older
 
 
 
* How many children under the age of 18 live in your household?
 
0
 
1
 
2
 
3
 
More than 3
 
 
 
* Into which range does your total annual household income fall?
 
Under $30,000
 
$30,000 - $50,000
 
$50,001 - $75,000
 
$75,001 - $100,000
 
$100,001 - $150,000
 
Over $150,000
 
 
 
* Into which ethnic group do you classify yourself?
 
Caucasian or white
 
African-American or black
 
Hispanic or Latino
 
Asian
 
Other
 
 
 
* Please provide your zip code
   
 
 
 
Please provide the email address where you can best be reached.
   
 
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