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The Green Spot Survey
Progress: 
 
This survey is intended to gather information about the consumers using The Green Spot and what types of businesses, products, services, and information they are seeking in The Green Spot.  We will not share your contact or personal information with others.  Thank you for taking our survey and helping us improve Central Oregon's directory for sustainable living.  


Personal Information
 
1.
Please fill in your name and contact information.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:

2.
I would like to recieve information from The Environmental Center by:
Email
Mail
Both
None of the above
3.
Gender:
Male
Female
4.
What is your age?
Under 21
21-30
31-40
41-50
51-60
65+
5.
What is the furthest level of education you have completed?
 

  • 50 character(s) left.
6.
What is your annual household income?
less than $25,000
$25,000-$50,000
$50,000-$75,000
$75,000-$100,000
$100,000-$125,000
$125,000-$150,000
$150,000+
7.
How many children, 18 or under, are currently living in your household?
 

  • 50 character(s) left.
8.
Do you own or rent your home?
Own
Rent
9.
Do you plan on buying a home in the next 12 months?
Yes
No
10.
Do you plan on building a home in the next 12 months?
Yes
No