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Gender Select Male Female
Date of Birth Month January February March April May June July August September October November December
Day Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Year
Marital Status Select Married Single Engaged Living with Partner Separated Divorced Widowed
Income Select Under $15,000 $15,000-$19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $74,999 $75,000 - $99,999 $100,000-$149,999 $150,000-$199,999 $200,000-$249,000 $250,000 or More
Industry Select Accounting / Finance Advertising Agriculture Airline / Aviation Architecture - Building Art / Photography / Journalism Automotive / Motor Vehicles / Parts Banking / Financial Services Biotechnology Broadcasting / Radio / TV / Media Building Materials Chemical Construction Charitable / Not for Profit Computer Hardware Computer Software Consulting Consumer Products Credit - Loan - Collections Defense / Aerospace Education / College Electronics Employment Recruiting and Staffing Energy / Utilities / Gas / Electric Entertainment Environmental Exercise / Fitness Fashion / Apparel / Textile Food Funeral - Cemetery Government / Civil Service Healthcare / Health Services Hospitality Hotel / Resort Human Resources HVAC Import / Export Industrial Insurance Information Technology Internet Landscaping Law Enforcement Legal Library Science Managed Care Manufacturing Media Merchandising Military Mortgage Office Supply / Equipment Oil Refining / Petroleum / Drilling Packaging Pharmaceutical Printing / Publishing Programmer Public Relations Real Estate / Property Mgt Restaurant Retail Recreation Sales / Marketing Securities Security Semiconductor Social Services Software Developer Telecommunications Training Transportation Travel Utilities (electricity, gas, water) Web Designer Wireless Other
Job Title Select Associate Manager Director VP COO CIO CTO CFO CEO Accountant Account Executive Administrative Professional Analyst Assistant or Clerical Staff Architect College or University Professor College or University Staff Customer Service Rep Doctor Engineer Executive Human Resources Insurance Brokers Lawyer Marketing Manager Meeting/Event Planner RN LPN Owner Purchasing Manager Project Manager Retired Sales Media Buyer Travel Agent Real Estate Agent Real Estate Broker Mortgage Broker Facilities Manager Network Admin Web Developer Software Developer Programmer Specialist Teacher K-12 Cardiologist Chiropractor Dentist Dermatologist Dietitian General Surgeon Internal Medicine Massage Therapist Nurse OB/GYN Occupational Therapist Ophthalmologist Optometrist Orthopedic Surgeon Pediatrician Pharmacist Physical Therapist Plastic Surgeon Plumber Podiatrist Primary Care (GP/FP) Psychiatrist Radiologist Veterinarian Other
Employee Size Select 0-10 11-25 26-50 51-100 101-250 251-500 501-1,000 1,001-5,000 5,001-10,000
Do you have purchasing authority? Select Yes No
Company revenue Select Under $500K $500K - $1 Million $1 Million - $5 Million $5 Million - $10 Million $10 Million - $20 Million $20 Million - $50 Million $50 Million - $100 Million $100 Million - $500 Million $500 Million - $1 Billion $1 Billion and Up
Are you a primary decision maker with regard to purchasing corporate gifts on behalf of your company's employees and their clients? Select Yes - I am a primary decision maker Yes - I am an influencer No - I am not involved at all
Are you a primary decision maker or are you an influencer with regard to planning corporate events and seminars for your company? Select Yes - I am a primary decision maker Yes - I am an influencer No - I am not involved at all
Are you interested in a career change? Select Yes - ASAP Yes - in 3 months or less Yes - in 6 months or less Yes - in the next year No
Does your job require you to travel? Select Yes No
What type of transportation do you use to travel for business? Select Airplane Car Train
How often does your job require you to travel? Select Once a year Twice a year Three times a year Four times a year Weekly Monthly Never
Are you interested in starting a new business? Select Yes No
Are you considering a business opportunity? Select Yes No
Are you considering a franchise opportunity? Select Yes No
What type of business industry are you interested in? Select Accounting / Finance Advertising Agriculture Airline / Aviation Architecture - Building Art / Photography / Journalism Automotive / Motor Vehicles / Parts Banking / Financial Services Biotechnology Broadcasting / Radio / TV / Media Building Materials Chemical Construction Charitable / Not for Profit Computer Hardware Computer Software Consulting Consumer Products Credit - Loan - Collections Defense / Aerospace Education / College Electronics Employment Recruiting and Staffing Energy / Utilities / Gas / Electric Entertainment Environmental Exercise / Fitness Fashion / Apparel / Textile Food Funeral - Cemetery Government / Civil Service Healthcare / Health Services Hospitality Hotel / Resort Human Resources HVAC Import / Export Industrial Insurance Information Technology Internet Landscaping Law Enforcement Legal Library Science Managed Care Manufacturing Media Merchandising Military Mortgage Office Supply / Equipment Oil Refining / Petroleum / Drilling Packaging Pharmaceutical Printing / Publishing Programmer Public Relations Real Estate / Property Mgt Restaurant Retail Recreation Sales / Marketing Securities Security Semiconductor Social Services Software Developer Telecommunications Training Transportation Travel Utilities (electricity, gas, water) Web Designer Wireless
I would like to receive additional information from third party advertisers related to my above interests. Select Yes No
