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Sex?
 
Female
 
Male

 
 
 
Relationship Status?
 
Single
 
Married
 
Engaged
 
Life Partner

 
 
 
Your Age?
 
18 - 20
 
21 - 24
 
25 - 29
 
30 - 34
 
35 - 39
 
40 - 44
 
45 - 49
 
50 - 54
 
55 - 59
 
60 - 64
 
65 - 70
 
Other
 

 
 
 
How many people live in your household?
 
0
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
9
 
10

 
 
 
How many children under the age of 18 lives in your home?
 
0
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
9
 
10

 
 
 
What are the ages of the all the children under the age of 18 that lives in your home? Seperate each number with a comma. Example: 4, 10, and 13.
   
 
 
 
Annual Income (Before Taxes)?
 
$0 - $15,000
 
$16,000 - $24,000
 
$25,000 - $34,000
 
$35,000 - $44,000
 
$45,000 - $54,000
 
$55,000 - $64,000
 
$65,000 - $74,000
 
$75,000 - $84,000
 
$85,000 - $94,000
 
$95,000 - $104,000
 
Other
 

 
 
How prepared are you for common disasters in your area?
Very Prepared Somewhat Prepared A little Prepared Have Knowledge to get Prepared Not Prepared
Winter storm
Fire
Hurricane
Tornado
Landslide/debris flow
Wildfire
Tsunami
Hazardous materials
Volcanic eruption
Heat wave
Nuclear incident
Terrorism
 
 
 
Would you be interested in Disaster preparedness services?
 
Yes
 
No
 
Maybe

 
 
 
Would you be interested in Disaster preparedness services?
 
Yes
 
No
 
Maybe

 
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