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Name *
Last Name
Age *
Gender *
Male
Female
Mobile Number *
Primary Language
Country *
State *
Street address *
City *
Zip code *
Please specify your ethnicity *
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White
Hispanic or Latino
Black or African American
Native American or American Indian
Asian / Pacific Islander
Login Details
Email ID *
Password *
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Education Details
What is the highest degree or level of school you have completed? If currently enrolled, highest degree received.
Select One
Nursery school to 8th grade
Some high school, no diploma
High school graduate, diploma or the equivalent (for example: GED)
Some college credit, no degree
Trade/technical/vocational training
Associate degree
Bachelor’s degree
Master’s degree
Professional degree
Doctorate degree
Household Composition
What is your marital status?
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Single, never married
Married or domestic partnership
Widowed
Divorced
Separated
Household Income
Total number of Children
Professional Details
Employment Status
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Employed for wages
Self-employed
Employed full-time
Employed part-time
Contract, Freelance or Temporary Employee
Out of work and looking for work
Out of work but not currently looking for work
A homemaker
A student
Military
Retired
Unable to work
Occupation
Annual income before taxes ?
Select One
Less than 15,000
15,000-24,999
25,000-49,999
50,000-74,999
75,000-99,999
100,000-149,999
150,000-199,999
200,000-249,999
250,000 or greater
Which of the following best describes the industry that you, parsonally, work in ?
Select One
Carpenting/Electrical Installations/VVS
Banking/Financial
Consumer Packaged Goods
Government/Public Sector
Healthcare
Hospitality/Tourism
Human Resources
Energy/Utilities/Oil and Gas
Legal/Law
Advertising
Accounting
Manufacturing
Real Estate/Property
Food/Beverage
Retail/Wholesale Trade
Environmnetal Services
Computer Reseller (Software/Hardware)
Telecommunications
Transportation
Information Technology/IT
Agriculture/Fishing
Consumer Electronics
Architecture
Automotive
Computer Hardware
Pharmaceuticals
Fashion/Apparel
Education
Marketing/Sales
Bio-Tech
Media/Entertainment
Military
Non Profit/Social Services
Personal Services
Printing Publishing
Public Relation
Security
Shipping/Distribution
Sales
Aviation
Brokerage
Chemicals/Plastics/Rubber
Communication/Information
Computer Software
Construction
Consulting
Engineering
Insurance
Internet
Market Research
Other
I don't work
Approximately how many employees work at your organization (all locations) ?
Select One
1 to 49 employees
50 to 249 employees
250 to 499 employees
500 to 999 employees
1,000 to 1,999 employees
2,000 to 4,999 employees
5,000 to 9,999 employees
10,000 to 49,999 employees
50,000+ employees
What is your job title, level or respnosibility ?
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Company Owner/Founder
Partner
Board Director
C-Level Executive
Senior Manager
Middle Manager/Department Manager
Junior Manager/Supervisor/Team Leader
Non-Managerial Employee
None of the above
Please choose in which departments you work within your organization?
Select One
IT Hardware
IT Software
Printers and Coplers
Financial Department
Human Resources
Office Supplies
Corporate Travel
Telecommunication
Sales
Shipping
Operations
Legal Services
Marketing/Advertising
Security
Food Service
Auto leasing/Purchasing
Other
Approximately what is the annual revenue for your organization ?
Select One
Under 100,000
100,000-249,999
250,000-499,999
500,000-999,999
1 Million-4.99 Million
5 Million-9.99 Million
10 Million-24.99 Million
25 Million-49.99 Million
50 Million-99.99 Million
100 Million-249.99 Million
250 Million-499.99 Million
500 Million-999.99 Million
1 Billion or more
I don't work
