Please record your contact details.


Title:



Given name:



Surname:



Phone number:



E-mail:




Can you please tell me your city of residence?

Sydney
Melbourne
Brisbane
Adelaide
Perth
Canberra
Other (Please specify)


Can you please tell me the suburb you live in?



And your postcode?




Can you please tell me which age group you belong to?



And your gender?



Are you currently...

Working full-time in paid labour force
Working part-time/casual in paid labour force
Unemployed/ looking for work
Full time student
Retired/ Pensioner
Self employed
Other (Please specify)


Your occupation?

Professional
Senior government
Business manager or executive
Business owner or self employed
Sales or clerical
Technical or skilled trades person
Semi-skilled (eg. drivers)
Primary producer / farmer
Manual worker
Other (Please specify)


Which industry do you work in?

Agriculture, Forestry and Fishing
Mining
Manufacturing
Electricity, Gas and Water Supply
Construction
Wholesale Trade
Retail Trade
Accommodation, Cafes and Restaurants
Transport and Storage
Communication Services
Finance and Insurance
Property and Business Services
Government Administration and Defence
Education
Health and Community Services
Cultural and Recreational Services
Personal and Other Services
Other(Please specify)


Can you please tell me your annual household income before tax?



And can you please tell me your household structure?

Single
Married, no children
Married, children at home
Single parent, children at home
Single parent, no children at home
Married, children left home
Widowed, divorced, seperated, children at home
Widowed, divorced, seperated, no children at home


How many children live at your home?



Do you own or rent your home?

Own/ buying
Rent
Other (Please specify)


What is the main language spoken at home?

English
Other (Please specify)


What is your country of origin?

Australia
UK
NZ
Vietnam
China
Thailand
Japan
Other Asian
France
Greece
Italy
Germany
Other Europe
India
Pakistan
Egypt
North America
Africa
South America
Other (Please specify)


What is your highest level of education?




How often do you fly interstate?

More than 2 years
At least every 2 years
Once a year
More than once a year (Please specify)
Less than once a year


How often do you fly overseas?

More than 2 years
At least every 2 years
Once a year
More than once a year (Please specify)
Less than once a year


Are you the main grocery buyer?




Are you a member of a private health fund?




Do you have a licence?




And do you own (are you paying off) a car?




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