* 1. Your name:

* 2. Your age:

* 3. Your telephone number:

* 4. Your e-mail address:

* 5. Where are you based?

* 6. Which of the following best describes you:

* 7. Based on your selection(s) above, what are your latest experiences in relation to donating/fundraising?

* 8. Are you affected by cancer?

* 9. Have you received information and/or support from Maggie's through any of the following channels:

* 10. Is there a reason for you making this choice (i.e. you chose online only because you can't physically get to a centre)?

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