Gender
(please specify your gender)
When we e-mail you, how would you like us to address you?
Which one of the following best describes your age group?
Which ethnic group or groups do you belong to?
To which Iwi do you belong?
Which best describes your household's annual income before tax?
Which best describes your annual personal income before tax?
Are you in paid employment?
Which of the following best describes your involvement in making decisions on behalf of your household? (optional)
During the last 12 months, have you personally participated in any decision on behalf of your employer or company to purchase goods or services to the value of...? (optional)
Your telephone numbers
(one required)
We would like at least one telephone number to verify your registration and to contact you if you win prizes! All information is
confidential.
Local Government Area
Suburb (for Auckland Region Only)
Parliamentary Electorate