Please note that all fields followed by an asterisk must be filled in. Age range
---Select--- \nA 21-30
B 31-40
C 41-50
D 51-60
E 61-70
F 71-80
G>80
Gender
---Select--- \n Male
Female
Marital Status
---Select--- \nA Married
B Single
C Divorced
D Widowed
E Separated
How Many Children at home?
---Select--- \n0
1
2
3
4
5
>5
How Many Grown Children do You Have?
---Select--- \n0
1
2
3
4
5
>5
How many grandchildren do you have?
---Select--- \n0
1
2-5
5-10
10-15
>15
Highest Education Attained
---Select--- \nA Elementary
B Secondary
C Bachelors Degree
D Masters Degree
E PHD
F Vocational
Annual Income Bracket
---Select--- \nA <$50,000
B $50,000 - $75,000
C $76,000 - $100,000
E $100,000 - $250,000
F $251,000 - $500,000
G $501,000 - $1,000,000
H >$1,000,000
Do you regularly buy grass fed beef?
---Select--- \n Yes
No
If you regularly buy grass fed beef, where do you usually buy it?
---Select--- \nA Local producer direct
B Local Farm Market
C Local retail - store/restaurant
D Large Chain Health Food Store
E Supermarket
F Internet
G N/A Don't regularly purchase
How important is it to you that you know where your food comes from and how it was raised?
---Select--- \nA Very important
B Fairly important
C Somewhat important
D Not that important
E Not at all important
Rate your overall health and vitality
---Select--- \nA Feel great most of the time
B Feel pretty good most of the time
C Feel OK most of the time
D Sometimes don't feel good
E Often don't feel good
F Almost never feel good
Medical Conditions: Have you been diagnosed with any of the following?
---Select--- \nA None
B Diabetes
C Heart Disease
D Stroke
E Cancer
F Loss of bone density
G Hepatitis A, B, or C
H Other
Religion
---Select--- \nA I am deeply religious
B I am fairly religious
C I am somewhat religious
D I am slightly religious
E I am not religious at all
F I am spiritual but not religious
G I am agnostic
H I am atheist
Did you search for grass fed because you heard it may imporove your health?
---Select--- \nYes
No
Maybe
What is the primary thing that interests you about grass fed?
---Select--- \nA General health benefits
B Omega 3
C CLA
D Antioxidants
E Weight loss potential
F Manage chronic disease
G Humane animal treatment
H Rural agrarian lifestyle
I Western ranching lifestyle
J Land conservation & Protection
How often do you eat beef?
---Select--- \nA <1 meal / week
B 1 - 3 meals / week
C 4 - 6 meals / week
D > 6 meals / week
When you eat beef do you make it a point to eat grass fed?
---Select--- \nA Most of the time
B Some of the time
C Now and then
D Rarely
E Almost Never
I like to participate in the following activities:
---Select--- \nI will answer to following
I will not answer to following
Hiking
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Walking
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Golfing
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Alpine Skiing
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Nordic Skiing
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometime
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Snow Boarding
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Horseback riding
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Bicycling
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Swimming
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Water Skiing
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Dancing
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Rock Climbing
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Jogging
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Motorcycle Riding
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Driving Fast Cars
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometime
D I do now and then
E Very rarely
F Almost never
Hunting
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Fishing
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Ocean Cruises
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Drinking wine
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometime
D I do now and then
E Very rarely
F Almost never
Drinking Beer
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
Dining Out
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
Gourmet Cooking
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
Cooking At home
---Select--- \nA I love it and do it regularly
B I like to do it a fair bit
C I like to sometimes
D I do now and then
E Very rarely
F Almost never
G Used to a lot, not so much now
First Name*
First Name*
E-mail Address*
E-mail Address*
State/Prov
