Personal Info.
E-mail Address:
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First Name:
Last Name:
Address 1:
Address 2:
City:
State:
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DE
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Other
Zip Code:
Phone Number: (123) 456-7890
The following information will be used to help us classify your answers and compare them in general to the other people participating in RestaurantPoll.com.
Once you have registered, you will always be able to go straight to the surveys without having to complete this section again.
Demographics
Are you:
Male
Female
Year of birth (ie. 1976)
-Select-
1993
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How many people are currently living in your household?
-Select-
1
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Are there currently any children under the age of 18 living in your household?
What is the last grade of school you completed?
Which of the following best describes your ethnic group?
In which of the following groups does your household's total annual income fall?
During the past 30 days, approximately how many times have you patronized:
any full service/sit-down restaurant?
Select One
0
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90
Select One
0
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90
(Include all breakfast, lunch, dinner, and snack occasions, regardless of whether you
ate inside the restaurant, used the drive-thru, used carry-out, or had the food delivered)
Communications Options
Do you currently work in the food service industry?
