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First Name
Last Name
Age	Please select one under 18 18-25 26-29 30-39 40-49 50-59 60 or over
Gender	female male
Education	Please select one grammar/middle school high school diploma some college bachelor's degree graduate degree
Marital Status	Please select one single married divorced other
Children in Household	Please select one 0 1 2 3 4+
Address
City
Country	Please select country Antigua and Barbuda Argentina Armenia Aruba Australia Austria Bahamas Belgium Brazil Bulgaria Cameroon Canada Cape Verde Cayman Islands China Costa Rica Czech Republic Cyprus Denmark Egypt Fiji Finland French Guiana French Polynesia Germany Greece Greenland Hong Kong Hungary Iceland Ireland Israel Italy Jamaica Japan Korea, Republic of Latvia Lithuania Netherlands Netherlands Antilles New Caledonia New Zealand Norway Oman Philippines Poland Portugal Romania Saint Lucia Saint Vincent and the Grenadines San Marino Saudi Arabia Yugoslavia Singapore Slovenia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Thailand Turkey Ukraine United Arab Emirates United Kingdom United States
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ZIP or Postal Code
Home Phone
Occupation	Please select one accounting/finance executive/senior management professional/managerial technical/engineering administrative/secretarial sales/marketing/advertising customer service/support college/university faculty college/university student k-12 student writer/journalist homemaker retired currently not employed other
Company Name
Organization Type	Please select one internet-related services television/radio/print publishing printing/graphics entertainment advertising/media/public relation marketing/communications sales software development k-12 education college/university education government finance/banking/accounting architecture/engineering/construction medical services legal services wholesale/retail transportation/utilities consulting nonprofit agriculture/forestry manufacturing/distribution other
Company Size	Please select one under 10 employees 10-99 employees 100-499 employees 500-999 employees 1000-9999 employees 10000+ employees
Work Phone
Primary Net Connection	Please select one at home at work at home business at K-12 school at college/university at library/public terminals other
Internet Experience	Please select one under 6 months 6 months - 1 year 1-2 years 3+ years