| HOW MANY TIMES A YEAR... |
1-3 4+ Do you travel Internationally |
| 1-34+ Do you travel Domestically |
HOW MANY TIMES A WEEK...
|
| 1-34+ Do you Play Cards |
| 1-34+ Play Bingo |
| 1-34+ Watch Television |
| 1-34+ Enjoy Casino Trips |
| 1-34+ Read for Pleasure |
| 1-34+ Use the Internet |
| 1-34+ Talk on the Phone with Family or Friends |
| 1-34+ Visit Family or Friends |
| 1-34+ Go to the Senior Center |
| 1-34+ Go out to Eat |
| 1-34+ Use Coupons |
| 1-34+ Go to the Library |
| 1-34+ Go to the Movies |
| 1-34+ Play Nintendo WII |
| 1-34+ Do Volunteer Work |
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| YesNo Are you fully retired from active work? |
| YesNo Are you semi-retired (10+ hr/wk)? |
| YesNo Are you a retiree who volunteers? |
| YesNo Do you use homeopathic remedies? |
| YesNo Are you on prescribed medications? |
| YesNo Do you take a daily vitamin of any kind? |
| YesNo Do you have a computer? |
| YesNo Do you have a cell phone? |
| YesNo Do you have Email? |
| YesNo Do you subscribe to Not Born Yesterday! |
PERSONAL
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Birthdate
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| GenderMaleFemale |
Nationality
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Religion
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HAVE YOU PURCHASED IN THE LAST MONTH
|
| YesNo Purchased a Car? |
| YesNo Moved to a Retirement Community? |
| YesNo Purchased Over the Counter Medications? |
| YesNo Purchased Flowers? |
| YesNo Purchased Gardening Supplies? |
| YesNo Purchased Pet Supplies? |
| YesNo Purchased Hearing Aids? |
| YesNo Purchased Glasses |
HAVE YOU USED SERVICES IN THE LAST MONTH:
|
| YesNo Hair, Nails, or Beauty services |
| YesNo Massage or Physical Therap |
| YesNo Car Repairs? |
| YesNo Home Repairs? |
| YesNo Gardening Services? |
| YesNo Pool Services? |
| YesNo Cosmetic Surgery? |
|
How you Know About Not Born Yesterday!
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