1. Last Name: M.I. First Name:

2. Are you: Female Male

3. Age: 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 years old.

4. Occupation: Dummy Or Other:

5. Hobbies:

6. Do you buy/sell/swap anything from other sites on the web? Yes No

7. Please describe what (e.g. swap music, buy books, etc.):

8. Any suggestions to help us improve our service?

9. Your email: