This survey is designed to find out how active you currently are and what activities you would like to see in your area. The information you provide will only be shared with partners directly involved in the 'Let's Get Moving Cambridgeshire' project, including District Councils across Cambridgeshire and Living Sport.

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* 1. Gender:

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* 2. Age Group:

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* 3. Do you consider yourself to have a disability?

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* 4. Postcode/Town:

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* 5. Name:

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* 6. Contact details: Email/Telephone number:

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* 7. We would like to get an overall picture of your current level of physical activity. For this purpose, being physically active means doing activities that raise the heart rate and make you breathe faster in bouts of 10 minutes or more. This might include a brisk walk, gardening or housework, or running, going to the gym etc.

How much weekly activity would you say you did?

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* 8. Would you like to be more physically active?

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* 9. If you are currently active for less than 30 minutes a week, what are the main reasons for this?

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* 10. If you regularly take part in physical activity or sport, what motivates you to do so? e.g. keeping fit? social life?

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* 11. Are there any particular activities you would like to see offered in your area? Please specify

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* 12. When would you like these activities to happen? e.g. Monday after 6pm

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* 13. OPTIONAL ADDITIONAL INFORMATION:

Which race/ethnicity best describes you? (Please choose only one.)

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* 14. Which of the following categories best describes your employment status?

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