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:
YES NO At Work
YES NO With Friends
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