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Questions marked with a * are required Exit Survey
 
 
What is your age? 
 
18-24
 
25-34
 
35-44
 
45-54
 
55-64
 
65-74
 
75+

 
 
 
What is the highest level of school you completed or the highest degree you have received? 
 
less than high school degree
 
High school degree or equivalent (e.g., GED)
 
Some college but no degree
 
Associate degree
 
Bachelor degree
 
Graduate degree

 
 
 
On which continent were you born?
 
Africa
 
Antarctica
 
Asia
 
Australia
 
Europe
 
North America
 
South America

 
 
 
* Please describe your race/ ethnicity
   
 
 
 
What types of credit cards do you have (Select all that apply)?
 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club

 
 
 
Are you Male or Female
 
Male
 
Female
 
 
 
How often do you drink alcholic beverages?
 
Everyday
 
At least once a week
 
Once a week
 
At least once a month
 
Less than once. Month
 
 
 
How many drinks on average do you have at one time?
 
Less than 1
 
1 or 2
 
3 or 4
 
5 or 6
 
6+

 
 
 
* Has your drink ever been tampered with? Yes/No, if yes where were you?
   
 
 
 
* If no, do you know someone who had this happen to? Yes / no, If yes, where were they?
   
 
Mind the Sip