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First Name

Last Name

Email Address

Gender

Female

Male

Birth Date

- - (Use 4 digits for the year)

Street Number:

Street Name:

Suburb or Town:

State:

Country:

Postcode

Daytime Contact:

In an average week, how much time do you spend listening to the radio?

Fewer than five hours per week		Five to 10 hours per week		More than 10 hours per week

In an average week, how much time do you spend watching television?

Fewer than five hours per week Five to 10 hours per week More than 10 hours per week

Do you have regular access to PAY TV (Foxtel, Optus, Austar)?

Yes No

How often do you send/receive email? (personal and/or business):

More than once per day Once per day A few times per week
Once per week A few times per month Once per month

How often do you surf the web?

More than once per day Once per day A few times per week
Once per week A few times per month Once per month

Favourite radio station:

Second favourite radio station:

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