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Employer
Job Title
Select What Best Describes Your Position
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Business Owner
Self Employed
White Collar
WC Professional specialist
WC Technical specialist
WC Executive, manager, administrator
WC Sales
WC Administrative support
Government Employee
Teacher
Blue Collar, Pink Collar
BC Skilled trade
BC Machine operator, assembler
BC Driver, mover
BC Laborer
BC Protection services
BC Food services
BC Health services
BC Custodial services
BC Personal services
Farming
Not employed
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Not employed - Student
Not employed - Retired
Not employed - Unemployed
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Military
Please enter the employment status which best describes you?
Working Full Time
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Not working-Stay at home parent
Student
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Disabled
Date Of Birth (MM/DD/YYYY)
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Gender
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Female
Male
Income Level
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0-25 K
25K - 50K
50K - 75K
75K - 100K
100K - 125K
125K - 150K
150K - 175K
175K - 200K
200K +
Highest Level of Education
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0-8th Grade
Some High School
High School Grad./GED
Some College
Associates
College Grad.
Advanced Degree
Race
Caucasian
Hispanic
African American
American Indian, Eskimo
Asian, Pacific Islander
Other
Political Party
Democrat
Republican
Independent
Ind/Leans Dem.
Ind/Leans Rep.
Not Registered
What Type Of Home Do You Live In
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Apartment
Condominium
House
Mobile home
Other
Martial Status
Divorced/Separated
Married
Single
Unknown/Refused
Widowed
Living with Partner
Spouse First Name
Spouse Last Name
Spouse Employment Status
Not employed
Less than 30 hours per week
30+ hrs
Full Time
Select What Best Describes Your Spouse’s Position
Business Owner
Self Employed
Third Choice
White Collar
WC Professional specialist
WC Technical specialist
WC Executive, manager, administrator
WC Sales
WC Administrative support
Government Employee
Teacher
Blue Collar, Pink Collar
BC Skilled trade
BC Machine operator, assembler
BC Driver, mover
BC Laborer
BC Protection services
BC Food services
BC Health services
BC Custodial services
BC Personal services
Farming
Not employed
Not employed - Homemaker
Not employed - Student
Not employed - Retired
Not employed - Unemployed
Disabled
Military
Self Employed
Do you have Children Living At Home Under 18?
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No
Yes
Child first name
Child last name
Child #1
Male
Female
Child #1 Birth Date
Child first name
Child last name
Child #2
Male
Female
Child #2 Birth Date
Child first name
Child last name
Child #3
Male
Female
Child #3 Birth Date
Child first name
Child last name
Child #4
Male
Female
Child #4 Birth Date
Child first name
Child last name
Child #5
Male
Female
Child #5 Birth Date
Child first name
Child last name
Child #6
Male
Female
Child #6 Birth Date
Date Entered
Date Updated
Do You have any pets?
Dog/dogs
Cat/cats
Fish
Bird/birds
Horse
Rabbit
Guinea Pig
Chickens
Rats
Turtle
Radio Station
95.7 WZID-FM
96.5 The Mill/WMLL
101 (101.1) WGIR
97.5 WOKQ
106.3 WHOB Frank FM
92.5 The River/WXRV
105.5 WJYY
Other
Don't know
98.5 WBMX
NHPR
Christian music
102.3 HAWK
107.9 KISS FM
WXRV
102.5-WKLB
94.9 - WHOM
94.5 - WJMN
93.7 MIKE
92.9 WBOS
105.7 WROR
104.5 - WXLO
96.1
106.7
100.7 - WZLX
1030 - WBZ
89.1 - WEVO
96.9 - Talk
104.1-WBCN
WRKO
103.3
Sirius Radio
100.3 - WHEB-Portsmouth
Classical
107.3 - WAAF
92.1 FNX
95.5 -
103.7
94.1
1250 WKBR
95.3 - WOLF
101.5 HAWK
106.1
98.1 JJR
93.9
101.7 - FNX
104.3
103.1
1450(am) - WKXL
100.1
93.3 WOLF
90.5
1370 (WFEA) am
89.7 WGBH
97.2 WFM
107.1 - WERZ -Portsmouth
1380 AM
98.7 - The Bay (Somersworth)
97.1 - WXRT
100.5 KIXX
91.1 WVNH
90.1
90.9 WKRB
XM Satellite
1290 amWKBK
99.5 - WCRB
99.3 WFRD
900 WMVU
980 WCAP
90.7-WDER
99.1
88.9 - ERS
102.7
101.3 WYKR
Religion
-----
Protestant
Catholic
Other Christian
Jewish
Other non-Christian
Agnostic/Atheist
Methodist
Congregational
Born Again
Evangelical
Baptist
none
Johovah Witness
Church Attendance
Never
once or twice a year
once a month
almost every week
every week
more than once a week
twice a month
Hobbies
Fishing
Skiing
Snowboarding
Boating/kayaking/canoeing
Hiking
Sewing
Painting
Scrapbooking
Reading
Walking
Running
Exercise/fitness
Shopping
Travelling
Antiques
Knitting/Crochet
Quilting
Stamping
motorcycles
automobiles
dirt bikes/4 wheeling
Biking
Movies
Dining
photography
gardening
Golf
Self defense
sports
crafts
Tennis
Soccer
Baseball
gymnastics
Camping
Coaching
Card games
Video/computer games
interior design-decorating/home improvement
Bowling
Rock Climbing
Hunting
Bingo
Horse racing
Archery
Cross stitching/needlepoint
Cooking
Wine tasting
Nature
Writing
Art
Music
swimming
snowmobiling
horseback riding
Nutrition
Nutrition
Dog training
Skateboarding
Scuba diving
Hockey
Woodworking
ATV's
Basketball
Baking
Auto racing - Nascar
Bird Watching
Softball
Dancing
Field Hockey
Skating/ice skating
Hot air ballooning
Flying
Jewelry Making
Astronomy
Outdoors sports/activities
Football
Weight training
Snowshoeing
Amusement Parks
Computers
Puzzles
volunteering
Lottery
Gambling
Racquet ball
dominoes
Drinking
genealogy
civic hobbies
action figures (collection)
stamp collecting
crossword puzzles
suduko
theater
Cheerleading
Foreign language
musical instruments
Metal detecting
Entertaining
Singing
Wine making
Volleyball
Rocks and minerals
Pool/billards
Boxing
train collecting
Weaving
Chess/checkers
models
Shooting
watersports
electronics
Kick ball
go-karts
Animation
Surf
Floral Design
Lacrosse
Pottery
basket making
church
day trade (Stocks)
politics
Farming
music producing
Horse shoes
education
comedy
yard sales
building
Radio controlled vehicles
coin collecting
Frisbee
Ski diving
Allergies
nuts
bees
Charities
United Way
Comcast Cares
Red Cross
Private Organizations
Boy Scouts of America
Girl Scouts of America
Marathon
Hanover Hills Nursing Home
Volunteer with
At place of worship
Second Choice
Athletic Association
Boy Scouts/Cub Scouts
Big Brother/Big Sister Program
Meals On Wheels
Girl Scouts/Brownies
Coaching
Visiting Angels (Pet therapy)
Massabesic Seniors
assists elderly
School
Hospice
Youth Program
Community involvement
Organization Participation
Harmony Inc. (singing) - nonprofit
Red Cross
American Assoc. of Architects
Hillsborough County Rep. Comm.
Senior Citizens
Christian Coalition
Civic Organizations
Lions Club
Official -elected or appointed
Selectman - Board
Stewardship Community
Cemetery Trustee
Hillsborough Co. Republican Comm
church official (treasurer, etc)
ILEEE Club (treasurer, president, etc)
Fire commissioner
Union affiliation
NFLPA
Local Union
IPBO
IBEW Local 490
Teamsters
Other Union
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