UAHS Membership Survey

1. Background Information Optional

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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)

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* 3. Are you male or female?

Male

Female

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* 4. What is your age?

18-20

21-29

30-39

40-49

50-59

60 or older

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

Employed

Not employed

Retired

Student

Other (please specify)