Full Name
Sex
Sex
------
Male
Female
Age
Age
Under 10
10-19
20-29
30-39
40-50
Over 50
City
State
State
--------
Other
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Country
Country
-----------
United States
Canada
Mexico
Other
Email
What browser are you using?
Browser
------------
Netscape Navigator
Internet Explorer
Other
Version
-----------
1.X
2.X
3.X
4.X
What speed modem do you use?
Modem Speed?
-----------------------
14.4 Kbps
28.8 Kbps
36.6 Kbps
56.0 Kbps
ISDN Line
Other
Don't Know
Do you have a web page?
Own Page?
-----------------
Yes
No
(If So) URL
Where is your computer?
Where?
-----------
Home
Work
Both
Other
How many times have you visited this site?
Times Visited?
-----------
1
2
3
4
5
Over 5
Have you found any mistakes?
Mistakes?
---------------
Yes
No
(If So) What were they?
Was it updated efficiently?
Updated?
--------------
Yes
No
What did you like best about the site?
What else do you think this site needs?
Do you think this is the best site of it's kind?
Best Site?
---------------
Yes
No
(If Not) What is the name of a better one?
What would you rate this site?
Rating?
-----------
1 (Poor)
2
3
4
5 (Okay)
6
7
8
9
10 (Best)
How did you find this site?
How Found?
-----------------
Yahoo
Friend
Advertisement
Other
Would you tell other fans about this site?
Tell Others?
-----------------
Yes
No
Have you enjoyed your current visit?
Enjoyed Visit?
---------------------
Yes
No
Do you plan on coming back?
Coming Back?
---------------------
Yes
No
Comments
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