1. First name
2. Last name
3. eMail
4. Gender

   Male Female

1. Age Group 18-24 25-34 35-44 45-60 60 and over

1. Income $18K-$24K $25K-$34K $35K-$50K $50K-$75K $75K and over

1. Children in home
2. Which of the following hobbies do you enjoy?

   Entertainment
   Shopping
   Outdoors
   Education
   Pets
   Travel / Leisure
   Health
   Books / Magazines
   Family
   
3. Comments

Julie Cachimbo
V.P. Sales
Programming
Business Development
office - 954.919.5678
cell - 954.305.1304
email - juliec@cachim.com