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Exit Survey
 
 
Name
   
 
 
 
Age
 
12-18
 
19-25
 
26-31
 
32+
 
 
 
What is your date of birth?
 
 
 
Sex
 
Male
 
Female
 
 
 
Race
 
White
 
Black
 
Coloured
 
Indian
 
Other
 
 
 
Occupation
   
 
 
 
Income bracket
 
R2000 - R5000
 
R5000 - R10000
 
R10000 - R15000
 
R15000 - R20000
 
R20000+
 
 
 
What province do you live in?
 
Gauteng
 
Mpumalanga
 
KZN
 
Northern Cape
 
Western Cape
 
Eastern Cape
 
Limpopo
 
Northwest Province
 
Freestate
 
 
 
What city do you live in?
   
 
 
 
Suburb?