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First Name

Surname

Gender (Please Select) Male Female (please specify your gender)

Your title eg: Prof, Dr, Mr, Mrs, Ms, Other

Your e-mail address

When we e-mail you, how would you like us to address you? First name only Title and full name Title and surname

Date of birth

Which ethnic group or groups do you belong to? Please select all that apply Asian

Indian

Maori

Middle Eastern/Arabic

NZ European/Pakeha

Other European (includes Australian, South African, British etc)

Pasifika

Other

Other (Please specify):

Which best describes your household's annual income before tax? (Select Household Income) Less than $20,000 per year Between $20,001 and $30,000 per year Between $30,001 and $50,000 per year Between $50,001 and $70,000 per year Between $70,001 and $100,000 per year Between $100,001 and $150,000 per year Between $150,001 and $200,000 per year More than $200,000 per year Don't know/ prefer not to say

Which best describes your annual personal income before tax? (Select Personal Income) Less than $20,000 per year Between $20,001 and $30,000 per year Between $30,001 and $50,000 per year Between $50,001 and $70,000 per year Between $70,001 and $100,000 per year Between $100,001 and $150,000 per year Between $150,001 and $200,000 per year More than $200,000 per year Don't know/ prefer not to say

Are you in paid employment? (Select Y/N) Yes No

Which of the following best describes your occupation? (Select Occupation) --Other-- Professional/Senior Government Official Business Manager/Executive Business Proprietor/Self-employed Teacher/Nurse/Police or other trained service worker Clerical/Sales Employee Farm Owner/Manager Technical/mechanical/Skilled Worker Labourer/Agricultural or Domestic Worker Home-maker (not otherwise employed) Student Retired/Superannuitant Unemployed/Beneficiary Don't know/prefer not to say

Other (Please specify)

What is the main activity of the business or employer you work for? (Select Main Business Activity) --Other-- Not applicable / not in paid employment Agriculture, Forestry or Fishing Manufacturing Construction Wholesale Trade Retail Trade Accommodation, Cafe or Restaurant Transport or Storage Communication Services Finance or Insurance Property or Business Services Government Administration or Defence Education Health and Community Services Cultural and Recreational Services Personal and Other Services Don't know/ prefer not to say

Other (Please specify)

Which of the following best describes your highest educational qualification? (Select Highest Qualification) --Other-- Postgraduate degree (Masters' degree or PhD) Undergraduate (Bachelor) degree Vocational qualification (includes trade certificates, diplomas etc) University Bursary or 7th form Sixth form/UE/NCEA Level 2 NCEA Level 1 or School Certificate No formal school qualification Prefer not to say

Other (Please specify)

Which of the following best describes your household? (Please Select) --Other-- Single person household Couple only (no children/none at home) Two parent family, one or two children at home Two parent family, three or more children at home One parent family, one or two children at home One parent family, three or more children at home Flatting or boarding - not a family home Extended family Prefer not to say

Other (Please specify)

Which of the following best describes your involvement in making decisions on behalf of your household? (optional) (Please Select) Primary decision-maker Equal Little or no decision-making responsibilities

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) (Please Select) Not applicable / not in paid employment Do not participate in purchase decisions $2,000 to $10,000 $10,001 to $20,000 $20,001 to $50,000 $50,001 to $100,000 $100,001 or more Prefer not to say

(one required)



Your telephone numbers We would like at least one telephone number to verify your registration and to contact you if you win prizes! All information is confidential. Mobile Phone: Best number - Day: Best number - Evening: Fax: You can contact me by text

Local Government Area (Select Local Government Area) Ashburton District Auckland Council Buller District Carterton District Central Hawke's Bay District Central Otago District Chatham Islands Territory Christchurch City Clutha District Dunedin City Far North District Gisborne District Gore District Grey District Hamilton City Hastings District Hauraki District Horowhenua District Hurunui District Hutt City Invercargill City Kaikoura District Kaipara District Kapiti Coast District Kawerau District Mackenzie District Manawatu District Marlborough District Masterton District Matamata-Piako District Napier City Nelson City New Plymouth District Opotiki District Otorohanga District Palmerston North City Porirua City Queenstown-Lakes District Rangitikei District Rotorua District Ruapehu District Selwyn District South Taranaki District South Waikato District South Wairarapa District Southland District Stratford District Tararua District Tasman District Taupo District Tauranga City Thames-Coromandel District Timaru District Upper Hutt City Waikato District Waimakariri District Waimate District Waipa District Wairoa District Waitaki District Waitomo District Wellington City Western Bay of Plenty District Westland District Whakatane District Whanganui District Whangarei District New Zealander living overseas

Suburb (for Auckland Region Only) (Select Suburb) Auckland > Franklin > Manukau > North Shore > Papakura > Rodney > Waitakere >

Post Code (optional)

Parliamentary Electorate (Select Parliamentary Electorate) Auckland Central Banks Peninsula Bay of Plenty Botany Christchurch Central Christchurch East Coromandel Dunedin East Coast East Coast Bays Epsom Hamilton East Hamilton West Hauraki-Waikato Hutt South Ikaroa-Rawhiti Ilam Invercargill Kaikoura Kaipara ki Mahurangi Kelston Mana Mangere Manurewa Maungakiekie Mt Albert Mt Roskill Napier Nelson New Lynn New Plymouth North Shore Northcote Northland Ohariu Otaki Pakuranga Palmerston North Panmure-Otahuhu Papakura Port Hills Port Waikato Rangitata Rangitikei Remutaka Rongotai Rotorua Selwyn Southland Taieri Takanini Tamaki Tamaki Makaurau Taranaki-King Country Taupo Tauranga Te Atatu Te Tai Hauauru Te Tai Tokerau Te Tai Tonga Tukituki Upper Harbour Waiariki Waikato Waimakariri Wairarapa Waitaki Wellington Central West Coast-Tasman Whanganui Whangaparaoa Whangarei Wigram New Zealander living overseas

Who did you vote for in the 2008 general election? (Party vote) (Select Party Vote 2008) ACT New Zealand Green Party Jim Anderton's Progressive Party Labour Party Maori Party National Party New Zealand First Party United Future Other party Chose not to vote Was not eligible to vote Don't know or can't remember

Who did you vote for in the 2011 general election? (Party vote) (Select Party Vote 2011) ACT New Zealand Conservative Green Party Labour Party Mana Party Maori Party National Party New Zealand First Party United Future Other party Chose not to vote Was not eligible to vote Don't know or can't remember

Who did you vote for in the 2014 general election? (Party vote) (Select Party Vote 2014) ACT New Zealand Conservative Party Green Party Internet-MANA Party Labour Party Maori Party National Party New Zealand First Party United Future Other party Chose not to vote Was not eligible to vote Don't know or can't remember

Who did you vote for in the 2017 general election? (Party vote) (Select Party Vote 2017) ACT New Zealand Conservative Party Green Party Labour Party MANA Movement Maori Party National Party New Zealand First Party The Opportunities Party United Future Other party Chose not to vote Was not eligible to vote Don't know or can't remember

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