| Thank
you for registering for the NZCPR research panel.
Please complete all of the fields in the
registration form as this will enable us to target research of specific relevance to
you. Your personal details or views
will never be revealed to others.
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| What
is your name? |
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| First
name |
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| Surname |
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| Gender
(please
specify your gender) |
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| Your
title (eg: Prof,
Dr, Mr, Mrs, Ms, Other) |
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| Your
e-mail address |
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| When
we e-mail you, how would you like us to address you? |
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| Which one of the
following best describes your age group? |
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| Which ethnic
group or groups do you belong to? |
Please
select all that apply
NZ
European/Pakeha
Maori
Pacific Islander
Asian
Indian
Other European
(includes Australian, South African, British etc)
Middle Eastern/Arabic
Other (Please
specify)
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| Which best describes
your household's annual income before tax? |
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| Which best
describes your annual personal income before tax? |
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| Which of the
following best describes your occupation? |
Other
(Please specify)
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| What is the main
activity of the business or employer you work for? |
Other
(Please specify)
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| Which of the
following best describes your highest educational qualification? |
Other
(Please specify)
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| Which of the
following best describes your household? |
Other
(Please
specify)
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| Which of the
following best describes your involvement in making decisions on behalf of
your household?
|
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| During the last
12 months, have you personally participated in any decision on behalf of your
employer or company to purchase goods or services to the value of...?
|
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| During
the last 12 months what is the value and category of
your biggest non-work related purchase?
|
(value) |
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(category)
Other
(Please
specify)
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| Your telephone
numbers |
Mobile Phone:
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Best number -
Day:
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Best number -
Evening:
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Fax:
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| Local Government
Area |
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| Parliamentary
Electorate |
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