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First Name:	Last Name:
Email Address:
Year of Birth:	Gender:
Address:
City:	Post Code:
State:	Phone:
Is your home:	How many children live in your home?
Do you own a mobile phone? Yes No	Mobile phone type?
Do you own pet(s)? Yes No
Who is primarily responsible for the household grocery shopping?
What is your personal income? (before tax)
Which describes your current employment situation?
Do you currently shop online? (Anytype of shopping, including food)
What opportunities are you most interested in? (tick all that apply) Business Computing Cooking Current Affairs Education Entertainment Gardening Geographical Health & Wellbeing Home Decorating Films and Movies Money & Investing Motoring Sport Travel Property Shares Other
What bargains, deals, competitions and discount opportunities are you interested in? (tick all that apply) Daily Discount deals (50-90% off deals) Free competitions to win cash, holidays or prizes Surveys to win cash Big name Offers and Bargains Catalogue Discounts (Target / Kmart) All the above