Media Survey

What is your age group?

What is your gender?

Male

Female

Non-Binary

Prefer not to answer

Zip/Postal Code

ZIP / Postal Code

Do you have children living at home?

Yes

No

If yes, what are the ages of the children in your household?

0-2

3-5

6-8

9-11

12-14

15-17

18+

What is your household income?

Under $25,000

$25,000 – $49,999

$50,000 – $74,999

$75,000 – $99,999

$100,000 – $149,999

$150,000+

Prefer not to answer