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Gender: Male Female Year of Birth: State or Country: Outside of US Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: (U.S. Only) How many children under 18 yrs old are in your household? None 1 2 3 4 5 6 or more Please select the birth years for any children under 18 in your household 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 Ethnicity: Asian, Asian-American Black, African-American Hispanic White, Caucasian Other Prefer not to answer Household Income: Under $20,000 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999 $50,000-$59,999 $60,000-$74,999 $75,000-$99,999 $100,000-$149,999 Over $150,000 Prefer not to answer

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