First Name:
Address line 1:
Address line 2:
City:
State:
Zip Code:
email:
Phone:
Age:
Select an option from the list 0-12 13-17 18-24 25-34 35-44 45-54 55-64 65 or older
Gender:
Select an option from the list Female Male Trans-gender
Ethnicity/race:
Select an option from the list African Asian European (white) Hispanic Middle-eastern Native American Pacific Islander A good mix of things
Marital Status:
Select an option from the list Single Married
How many children do you have?:
Select an option from the list none 1 2 3 4 or more
Education (select the highest level completed):
Select an option from the list Some high school High school Some college Associates degree Bachelors degree Masters degree Doctorate degree
Religion:
Select an option from the list Buddhist Christian Hindi Jewish Muslim Pagan Taoist Unitarian Shamanism Spiritual but not religious Other
Income level (per year):
Select an option from the list 0-$4,999 $5,000-$9,999 $10,000-$14,999 $15,000-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999 $50,000-$59,999 $60,000-$99,999 $100,000-$250,000 $250,000-$499,999 $500,000 plus
Profession (select the catagory that comes closest to your line of work):
Select an option from the list accounting & finance admin/office arch/engineering art/media/design biotech/science business/mgmt customer service education food/bev/hosp general labor government human resources internet engineers legal paralegal manufacturing marketing/pr/ad medical/health nonprofit sector real estate retail/wholesale sales/biz dev salon/spa/fitness security skilled trade/craft software/qa/dba systems/network technical support transport tv/film/video web/info design writing editing other
Food preference:
Select an option from the list Raw food Vegan Vegetarian Omnivore (with restrictions) Omnivore (unrestricted)
How many events have you attended at Earthlands in the past 2 years?:
Select an option from the list none 1 2 3 4 5 6 7 or more
What is your lodging preference?:
Select an option from the list Camping Dorm bunk Private room Private cabin
What would you be willing to pay for your lodging preference (per night)?:
Select an option from the list $10-$19 $20-$29 $30-$39 $40-$59 $60-$69 $70-$79 $80-$99 $100 or more
How much would you be willing to pay for a weekend event (including 2 nights lodging and meals)?:
Select an option from the list $50-$74 $75-$99 $100-$149 $150-$199 $200-$299 $300-$499 $500-$1000 Over $1000
Do you own your home?:
Select an option from the list Yes No
How many cars do you own?:
Select an option from the list 0 1 2 3 4 or more
What most attracts you to Earthlands?:
Select an option from the list The land The programs A specific program The people The vision
Could you see yourself living at Earthlands (in an eco-neighborhood)?:
Select an option from the list Absolutely! Yes, that sounds nice Maybe No
What is the most important issue you care about?:
Select an option from the list The environment Energy Education Politics Social justice Peace My issue is not listed
What else would you like us to know?:
