UAHS Membership Survey 1. Background Information Optional Page1 / 4 25% of survey complete. Question Title * 1. Contact Details Contact details must be provided to be entered into the draw for 1 years FREE membership and a FREE publication of your choice. UAHS may use the email address provided to keep you up to date with the work of the Society. If you would prefer not to be contacted by us in future please tick the box below at Q.2 Name Company Address Address 2 City/Town Postal Code County Email Address Phone Number Question Title * 2. Would you like to be contacted by the Society Yes No Other (please specify) Question Title * 3. Are you male or female? Male Female Question Title * 4. What is your age? 18-20 21-29 30-39 40-49 50-59 60 or older Question Title * 5. Which of the following categories best describes your employment status? Employed Not employed Retired Student Other (please specify) Next