£1 Member Profile Survey - Only 1 page, Email Address Same email address used when you registered at YourFreeSurveys.com (user name at YourFreeSurveys) Street Address Phone Number Primary language The language you speak at home with your family. English Spanish French German Other Ethnicity Please choose the term that best describes your ethnicity. Caucasian/White African American/Black Hispanic Asian Native American Other Religion Please choose the term that best describes your religious beliefs. Agnostic Atheist Buddist or Taoist Catholic Mormon Atheist Other Christian Hindu Judaism Muslim Spiritual but not religious Other Education level The highest level of education you have completed. High School Graduate GED Vocational/Technical School Some college Bachelor's Degree Masters Degree Doctorate Occupation Please choose the option that most closely matches your occupation. Administrative/Secretarial Artist/Creative/Performance Executive/Management Financial Service Homemaker Labor/Construction Legal Medical/Dental/Veterinary Retail/Food Service Sales/Marketing Student Teacher/Professor Technical/Computers/Engineering Travel/Hospitality/Transportation Other Household income This includes all members of your household. Less than 25,000 25,001 to 35,000 35,001 to 50,000 50,001 to 75,000 75,001 to 100,000 100,001 to 150,000 150,000+ Household size The number of people in your household including yourself. 1 2 3 4 5+ Marital status Single Married Divorced Widowed Living with partner Number of dependents The number of dependents you list on your tax documentation. 0 1 2 3 4 5+ Sexuality Please select the option that most closely matches your sexual preference. Heterosexual Homosexual Bisexual Other Do you currently make a mortgage payment? yes no What interests/activities apply to you or members of your household? (check all that apply) Furthering your computer knowledge Watching Movies Weight loss Coffee Collecting DVDs Collecting CDs Learning a 2nd Language Cooking Golf Active MySpace Account Starting a home business Investing Improving your fitness Get out of debt Start a new career Collect Comics Read Horoscopes Collect Disney Movies Need a better Credit Card Buy Jewelry online Do any of the following apply to you? (check all that apply) Wish to earn extra income from home Own a Pet Used Teeth Whitener in last year Own a Time Share Have Unwanted Wrinkles Own a Car Active Blogger Will buy a New Car this year Have Student Loans Use coupons Enjoy wine Subscribe to a magazine Ever had heartburn Think insurance is too expensive? Are Bald or Balding Have Diabetes Want to further your education? Near Sighted - Wear glasses Need a new Cell Phone Do you experience or suffer from any of the following? (Select all that apply) Acid indigestion Acid reflux disease ADD / ADHD (Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder) Adult acne AIDS Alcohol abuse Allergies -- Animals (dander) Allergies -- Environment (dust, mold) Allergies -- Food Allergies -- Seasonal (pollen, ragweed) Alzheimer's Anemia (iron deficiency) Angina Anxiety / panic disorder Arthritis Asthma Athlete's foot Back pain BPH (enlargement of the prostate) Bronchitis Cancer Chronic fatigue syndrome Chronic pain Cold / flu Colitis Conjunctivitis (pink eye) COPD (Chronic Obstructive Pulmonary Disease) Coronary heart disease Dandruff Depression Diabetes -- Type 1 Diabetes -- Type 2 Diarrhea Digestive disorder Drug abuse Dry skin Eating disorder (e.g., Anorexia, Bulimia, etc.) Emphysema Epilepsy Erectile dysfunction Eye irritations Gastro Esophageal Reflux Disease (GERD) Glaucoma Hair loss Halitosis (bad breath) Headache -- migraine Headache -- excluding migraine Hearing loss Heart ailment Heartburn Hemophilia Hemorrhoids Hepatitis A Hepatitis B Hepatitis C Herpes -- non-genital Herpes -- genital High cholesterol HIV Hypertension (high blood pressure) Incontinence Infertility Irritable Bowel Syndrome (IBS) Joint stiffness Leukemia Low sex drive Lyme disease Menopausal symptoms Menstrual pain / cramping / bloating Multiple Sclerosis Muscle aches Nail fungus Nausea / Vomiting Obesity Osteoporosis Parkinson's disease Periodontal (gum) disease Peripheral Arterial Disease (PAD) Peripheral Vascular Disease (PVD) Plantar warts Psoriasis Sexually transmitted disease (STD) Sickle cell anemia Sinusitis (or other sinus problems) Sleep disorder Stomach ailments (sour, upset) Stomach ulcer Stress Stroke Thyroid condition Underweight Urinary tract infection Yeast infection Bi-polar disorder Autism Restless legs syndrome Breast Cancer Dermatitis None of the above