Readership Survey

Demographic Information

1. Sex: Female Male

2. Age: Please Select Under 18 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85 or better

3. Relationship Status: Please Select Single Married Civil Union Domestic Partner Other

4. Children: Please Select 0 1-2 3 or more

5. Age of children: Infant    Pre-school     Elementary K-8     High School     College

6. How many individuals (including yourself) live in your household?

7. What is the highest level of education that you have completed: Please Select High School Some College Community College College Graduate Masters Degree Doctorate

8. Are you: Please Select Employed Unemployed Retired

9. Gross Personal Income you, personally earned in 2005: Please Select 15,000-19,999 20,000-29,999 30,000-39,999 40,000-49,999 50,000-59,999 60,000-69,999 70,000-79,999 70,000-89,999 90,000-99,999 100,000-125,999 126,000-149,999 150,000-200,000 over 200,000

10. Gross Household Income in 2005: (include all household members) Please Select 15,000-29,999 30,000-59,999 60,000-99,999 100,000-129,999 130,000-159,999 160,000-199,999 200,000-249,999 250,000-299,999 300,000-399,999 over 399,999

11. Which of the following comes closest to your occupation? (choose one) Please Select Homemaker Professional Management Educator Healthcare Business Owner Technical Sales Administration Trade Hospitality Other

Vermont Women as Readers

12. Do you regularly pass your issue of Vermont Woman on to others to read? Please Select Yes No

13. If yes to above question, about how many people, on a monthly basis, does your issue get passed to?
# of females # of males

14. I make or influence my household purchasing decisions: Please Select All 90% 75% 50% None

What I would like Vermont Woman to cover

What I like about Vermont Woman

(CONFIDENTIALITY INSURED)

Drawing to be held on April 1, 2006
Winner will be notified by phone or email.