Date of birth
*
Phone number
*
What is your gender?
*
Female Male Gender diverse
In what city do you live in?
*
Zip code/Post code
What is your current job title?
*
In what industry do your work in?
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Agriculture Automotive Aviation Banking, accountancy, insurance and other financial services Beauty/Cosmetics Business, consulting and management Charity and voluntary work Construction Creative arts and design Culture Education Energy and utilities Engineering and manufacturing Environment Food and drink Government, public services and administration Healthcare Hospitality and events management Information technology (IT) and computer services Law Law enforcement and security Leisure and sport Marketing, advertising and PR Media and entertainment Other/None of the above Professional business services Real Estate Recruitment and HR Retail Sales Science and pharmaceuticals Social care Technology Telecommunication Tourism Transport and logistics
What is your total annual household income (after tax)?
*
Below 30,000 30,000 - 40,000 40,000 - 50,000 50,000 - 60,000 60,000 - 70,000 70,000 - 80,000 80,000 - 90,000 90,000 - 100,000 Above 100,000
What is your highest completed education level?
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Associate degree Bachelor's degree Doctorate (PhD) High school diploma or GED Master's degree Professional degree Some college
What is your marital/relationship status?
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Cohabiting Divorced Living with housemate(s) Living with parents Married Single Widowed
Do you have children?
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Yes No
How many children do you have?
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1 2 3 4 5 More than 5
Do the age of the children in your household range from 0-17?
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Yes No
What best describes your ethnicity?
*
American Indian or Alaskan Native Black or African American Native Hawaiian or other Pacific Islander White Other
Specify your ethnicity:
*
If you are human, leave this field blank.
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