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1. What is your gender?
   Select One Female Male

2. What is your age?
   Select One Under 18 18-24 25-34 35-44 45-54 55+

3. What is your highest level of education?
   Select One Some High School High School Graduate Some College Associate's Degree Bachelor's Degree Post Graduate Degree

4. What is your occupation?
   Select One Student ProfessionalSelf-employedAdministrative/Clerical Executive/ManagementOther

5. What type of work do you do?
   Select One Creative/Design/Writing Sales/Marketing Educator Technical Medical/Legal Homemaker Government Other

6. Annual Household Income:
   Select One $20,001-$30,000 $30,001-$40,000 $40,001-$50,000 $50,001-$60,000 $60,001-$80,000 $80,001 +

7. Level of Fitness
   Select One FitRelatively FitNot Fit

8. Frequency of Excercise
   Select One Every DayA Few Times a WeekOnce a WeekRarely

9. How many of children do you have, if any?
   Select One 0 1 2 3+

10. If you have children, what are their ages? (Check all that apply)
    

    Under 1 1-5

    6-12 13-17

    18+

11. How long have you been online?
    Select One First Time 6 Months or Less 7 Months - 1 year 1-2 years 3+ years

12. How often do you go online?
    Select One First Time Less than once a week Once a week A few times a week Daily More than once a day

13. From where do you most frequently surf the Web?
    Select One Home Work School A friend's Cyber Cafe/Store Library Other