Optic

First name: *

Surname: *

Date of birth: * Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Email address: *

Password: *

Telephone:

Gender Male Female

Employment Status: Unemployed Student Employed Self-Employed

Salary £0 - £11,999 £12,000 - £17,999 £18.000 - £23,999 £24,000 - £29,999 £30,000 +

Which of the following social networking sites do you use? (Tick all that apply)
Facebook
Myspace
Bebo
DSI
Blogs

Which of the following radio stations do you listen to on a regular basis? (Tick all that apply)
Kiss
Radio Norwich
Radio Broadland
National/Other (please specify)

Which of the following Local publications do you read? (Tick all that apply)
EDP
Evening News
Concrete (UEA Paper)
Outline Magazine
Other (please specify)

During a typical week, how many evenings do you venture out to a bar or a nightclub?
Rarely or never
1-2
3-4
5-6
Every night

What nights of the week are you likely to visit Office? (Tick all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Did you know that by drinking at Office, you can obtain a Pub2Club pass which gives you free or discounted entry, Q-jump & VIP entry to Optic?
Yes No

If you could change one thing about Office or Optic, what would it be? Be honest!