Email Address: Qualification Questions: Date of Birth: (mm/dd/yy) Sex: Male Female Education: -- Select One -- Grade School Some High School Completed High School Completed College Graduate Degree Employment: -- Select One -- Student Work Part Time Work Full TIme Own Business Homemaker Not Working Geographic location: -- Select One -- USA Outside USA Please describe your industry: What type of Computer do you use? -- Select One -- IBM Compatible MAC Other How do you get to the internet? -- Select One -- Local Provider AOL MSN Prodigy Compuserv WOW Other online service How many people are in your household ? What is your marital status? -- Select One -- Single (Never Married) Married Divorced Separated Widowed Other How many hours a week are you on the internet? Have you ever purchased a product over the computer ? Yes No If selected as a prize winner may we use your name ? Yes No How did you hear about Voice of the Internet?