(Required fields are
bold
)
Email Address
*
First Name
Last Name
Gender
Male
Female
Age
Under 15
15-17
18-24
25-34
35-44
45-54
55-64
Over 65
Occupation
Unemployed
Student
Self-employed
Professional
Trade/Labourer
Service
Hospitality
I.T.
Clerical/Administration
Sales
Retail
Management
Defense/Military
Entertainment
Medical/Emergency Services
Homemaker
Retired
Number of Children
No children
1
2-3
4-5
More than 5
Ethnicity
NZ Maori
NZ European
NZ Asian
Samoan
Cook Islander
Asian
Other
