Reader Panel Application

As a Good Housekeeping reader your opinions are of tremendous value to us and to our advertisers. We are inviting you to become part of our exclusive Good Housekeeping Advisory Panel because we want to learn more about your lifestyle, your family and your interests. Should you be selected as a panel member, you will be asked to share your opinions several times a year through online surveys and possible panel discussions. These research surveys will help us better serve all our readers. Please fill out and submit the following questionnaire. We look forward to hearing from you, and we thank you in advance for your participation.

First Name:
Last Name:
Street Address:
City/State/Zip:   
Country:
Voice Phone:
E-Mail Address:

1. Are you?

Female Male

2.  In what year were you born?

3. What is your marital status?

Married
Single
Living in a committed relationship
Divorced/separated
Widowed

4. Please indicate the highest level of education that you have completed.

Post graduate studies/degree
Graduated college
Attended college
Graduated high school
Some high school or less

5. What is your current employment status?

Employed full-time
Employed part-time
Homemaker
Retired
Student
Not employed

6. If employed, what is your occupation?

7. Please indicate the ages of children in your household?

under 2 years
2-5 years
6-11 years
12-17 years
No children under 18 living at home

8. What is your total combined annual income, before taxes, of all household members including yourself?

Under $30,000
$30,000 - $49,999
$50,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000 - $249,999
$250,000 or more

9. Do you or your family own or rent, your primary residence?

Own house
Own condo/co-op/town house
Rent house
Rent apt/condo/co-op/town house
Other

10. Which of the following best describes your ethnicity?

White/Caucasian
Black/African-American
Hispanic/Latino
Multi-racial
Other

11. Which of the following best describes your relationship to Good Housekeeping Magazine?

Subscriber
Read someone else's copy
Buy it on the newsstand
Read Good Housekeeping online only
Do not read Good Housekeeping

12. Do you own a personal computer?

Yes No

13. Do you have access to the Internet .....?

At Home At Work Both

14. How often do you access the Internet?

Daily
Weekly
Monthly
Less than once a month

15.    How often do you typically visit goodhousekeeping.com?

2 or more times a week
Once a week
2-3 times a month
Once a month
Less than once a month
Today is my first visit to goodhousekeeping.com
I've never visited goodhousekeeping.com