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1) What is your age?
_ under 18 __ 18-24 _ 25-34 _ 35-4-4-
__ 4-5-4-9 _ 50-54 __ 55-59 __ 65 or OVCI’

2) You identify as:

_ Gay Male __ Lesbian __ Transgender __ Bisexual Male
__ Bisexual Female __ Straight Male__ Straight Female_ Don’t classify
myself

3) You are:

__ Single ~ __ Partnered __ Civilly United ‘ _ Married
__ Divorced _ widowed __ Other (Please Specify)

4-) What is your approximate annual household income?
_ under $l0,000__ S 10,000 — 19,999 __ $20,000 — 29,999
__ $4-0,000 — 49,999 __ $50,000 - $69,999 __ $70,000 - $99,999

_ $30,000 - $39,999
_ $100,000 or more

5) What is your highest-level of education?
_ some High School __ High School Graduate/GED _ Vocationalfrechnical '_iraining
_ Some College __ College Graduate _ Post graduate work/degree

6) What is your housing situation?
_ Own - __ Rent __ Other (Please Specify)
7) Do you plan to buy — or build — a house within the next year?
_ Yes _ No __ Considering

8) in the next year do you plan to buy or upgrade any of the following? (check all that apply)
_ Furniture _ Other Home Furnishings _ Home Electronics __ Home Appliances .
_ Carmucklvehicle __ Car Stereo Equipment __ Cell Phone __ Computer or Computer Related Equipment

9) Does your shopping ever include purchases for children?
_ Yes_ No

10) In which of the following activities do you or members of your household engage in regularly?

__ Skiing/Snowboarding __ Water Recreation __ Camping/Hiking/Climbing __ Going to the Movies
_ Renting DVDsNideos __ Going to the Theatre/Concerts _ Reading__ indoor Fitness Activities
__ Bicycling _ Gardening __ Other:

1 1) How often do you eat out? —
__ once a month or less __ several times a month __ once a week _ more than once a week

12) Would you travel an hour or so for any of the following?
. _ Arts/Cultural Events __ Dining _ Sporting Events _ Festivals _ Shopping
__ Other (Please Specify)

13) How often do you attend entertainmentlcultural events per month?
_ rarely or never_ 1-2 times _ 3-5 times __ 610 times __ more than 10 times

14-) How often do you travel (overnight away from home) for business or pleasure?
_ once a year or less __ 2-4 times a year _ 5-7 times a year
_ more than 10 times a year

_ 8-10 times a year

 
  

15) How many hours a week do you watch television?

_ never _ 1-5 hours __ 6-9 hours __ 1019 hours __ 20 or more hours
16) Do you use a computer at home?
__ Yes _ N0

17) Do you shop online?
_ Never _ Occasionally _ Often

18) What banking/financial services do you use? (check all that apply) (
__ Checking __ Savings _ Money Market __ IRA _ Mortgage _ Home-Equity Loan
__ Certificate of Deposit_ investment Services _ Other

19) which of the following do you read/listen to on a regular basis?

__ Seven Days __ Daily Paper__T__ (specify) ' _ Sunday Paper (specify)
__ Vermont Public Radio _ Other Radio (specify) __ Bay Windows _ lnNewsweekly
_ The Advocate__ Other GLBT publications (please list) '

__ Other Magazines (specify)