Full Name:

E-mail Address:

Resident Country:

Are You:  
 A first time visitor  A repeat visitor

Where did you find us:  

 Q Pages Hardcopy
 Advertising
 Another Website
 A Friend

What is your Age:

 Under 16
 16-18
 19-21
 22-25
 26-29
 30-34
 35-39
 40-49
 50-59
 60+

What is your Sexual Orientation:

  Gay
  Lesbian
  Homosexual
  Queer
  Bisexual
  Heterosexual
  Transgendered
  Unsure

Do you consider yourself to be OUT:

Out at work:  
 Yes  No

Out with friends:  
 Yes  No

Out with family:  
 Yes  No

With Family In the next election who would you most likely vote for (Australian Residents Only):

 Labour
 Liberal
 National
 Democrat
 Green
 One Nation
 Independent
 Unsure

Type of Residence:

 Own Your Home
 Paying Off Your Home
 Renting - alone
 Renting - shared
 Living with Family
 Other

Education:

 Year 10 High School
 Year 12 High School
 Apprenticeship
 Tafe/Technical College
 University/College Degree
 Post Graduate Qualification

Employment:

 Self Employed
Employed Full time 
Employed Part time 
 Student
 Seeking Work
 No Longer Working

What is your yearly income:

 AU$10,000 or Less
 AU$10,000 - AU$20,000
 AU$20,000 - AU$25,000
 AU$25,000 - AU$30,000
 AU$30,000 - AU$35,000
 AU$35,000 - AU$40,000
 AU$45,000 - AU$50,000
 AU$50,000 - AU$65,000
 AU$65,000 - AU$80,000
 AU$80,000 - AU$100,000
 AU$100,000+

Relationship:

 Single and happy to stay so
 Single - looking for same gender partner
 Single - looking for different gender partner
 Homosexually committed/married
 Heterosexually committed/married
 Other

Length of Relationship:

 Less than one month
 1-6 months
 6 months - 1 year
 1-2 years
 3-5 years
 6-10 years
 More than 10 years


If longer than 10 years - how long:

Household size:

 One
 Two
 Three
 Four
 Five or more

Do you live with your lover:

 Yes
 No

How often do you use Q Pages:

 Always
 Often
 Occasionally
 Seldom
 Never

Do you tell advertisers that you saw them in Q Pages or on the Q Pages Website:

 Yes
 No
 Sometimes

Have you purchased items through the internet:

 Yes
 No

How often do you Dine out per week:

 One
 Two
 Three
 Four
 Five or more

How many times do you go to gay/lesbian clubs per month:

 One
 Two
 Three
 Four
 Five or more

Total Vacation time in the last 12 months:

 One Week
 Two Weeks
 Three Weeks
 Four Weeks
 Five Weeks or more

Type of Vacation:

 Stayed at Home
 Visited own country
 Went Overseas
 Took a Cruise
 Other

Do you have a Website:

 Yes
 No

What is your opinion of our website:

 Fantastic
 Terrible
 Easy to Use
 Found good information
 Didn't find information

Will you use our site in the future:

 Yes
 No
 Not Sure

What would you like added to the site:

General Comments:

Would you like to receive further information:

 Yes
 No