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What languages do you speak? |
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| Preferred Language: |
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| Country of Residence: |
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Account Creation |
| E-mail Address: |
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| Verify E-mail Address: |
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| Password: |
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| Confirm Password: |
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Contact Information |
| First Name: |
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| Last Name: |
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| Address 1: |
(optional) |
| Address 2: |
(optional) |
| City / Town: |
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| County: |
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| Post Code: |
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| Phone number: |
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| Mobile phone number:
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| We often conduct other surveys, for example to try out new products, by mail or telephone. Can we call or mail you if we have this opportunity? |
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Personal Information |
| Gender: |
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| Birth Date: |
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| What is your marital status? |
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| At what age did you finish your education? |
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| Your employment status: |
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Other:
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| If working, Industry employed in: |
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Other:
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| If working, Type of Employment |
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| Ethnic Origin: |
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| In the last week, on how many separate occasions have you used the Internet, including e-mail, world wide web and other on-line services? |
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| In the last 4 weeks, how many times have you used the World Wide Web from home, work or elsewhere in order to purchase (by which I mean, pay for) products and services? |
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Household Information |
| What is your household's combined yearly income? |
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| Who owns the property you live in? |
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| How many people are in your household? |
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| Are you a parent of a child under 18 (by birth or adoption) currently living in your household? |
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| How many children do you have living in your household who are:
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| Under 5 years old |
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| 5 to 8 years old |
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| 9 to 11 years old |
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| 12 to 15 years old |
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| 16 to 17 years old |
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