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KB Research - Registration form
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Registration
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New
Re Registering
Update
Gender
*
M
F
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Surname
*
Your answer
First_Name
*
Your answer
Home_Phone
*
What is your home phone number or mobile number
Your answer
Work_Phone
Your answer
Mobile_Phone
What is your mobile number - if not above
Your answer
Internet_address
*
What is your EMAIL
Your answer
Enrolment_Age
*
Your answer
state
*
Choose
VIC
NSW
ACT
QLD
WA
SA
TAS
NT
Other
Suburb
*
What suburb do you live in
Your answer
Location
*
What Direction are you living in relation to your states CBD eg Melbourne, Sydney. NOTE: If you are not sure use this site -
https://www.bing.com/maps/
CBD
N
NE
E
SE
S
SW
W
NW
dist_from_cbd
*
How far do you live from you state capital city eg Melbourne, Sydney etc- In KMS
CBD
1-10
11-24
25-50
Regional
Marital_ Status
*
Single
Defacto
Married
Divorced
Widowed
ChildrensAge
How old are your children - even if you have adult children
Your answer
Housing
*
What best describes you housing arrangements. NOTE: Select home if you are living with your parents, and Buying if you have a mortgage.
Choose
Home
Renting
Buying
Own
Socio-Economic
What best decribes you type of work - Prof - Doctor, Lawyer, Engineer etc, SProf - Teacher, Nurse etc, Manager, Clerical, Retail, Trade - Tradesman, Manual - manual work ie factory hand, labourer etc,
PROF
SPROF
Manager
Clerical
Retail
Trade
Manual
Clear selection
Employment_ Status
*
What best describes you employment status - if a full time student put that down even if working part time
Full-Time
Part-Time
Casual
Home Duties
Student
Retired
Unemployed
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