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The Survey 



Name  _________________________


Good friends call me  _______________


We can schedule dinner parties on any night restaurants

are open.  Which night of the week is ordinarily

best for you?     M      T      W      TH      F      SAT      SUN


What dinner time is best for you:   6 PM   7 PM    8 PM


Your relationship status:  <Circle One>

  Single    Open relationship    Attached, but looking      

  Committed / Monagamous         Prefer not to say  


Do you have children?  <Circle One>

  Have children living at home    Have children, but not    

  living at home      Do not have children 


Your HIV status:

  <Circle One> Negative      Positive       Not Sure 


Your age range:

Under 30








60 or better



You consider looks to be: <Circle One>    

    The most important thing      Very Important 

    Moderately Important             Not Important    


You consider intelligence to be:  <Circle One>    

The most important thing      Very Important        

Moderately Important             Not Important    


Your favorite time of day:  <Circle One>

  Morning person       Night person   Up all the time  


You prefer to live in: <Circle One>

  Big City   Suburbia   Small town   Middle of nowhere 


Your political orientation:  <Circle One>

Extreme liberal        Liberal          Moderate             

Conservative          Extreme conservative 


In my life spirituality or religion is:

  Unimportant       Important      Very Important


I consider myself:

  Catholic          Protestant         Jewish       Other






Your pet(s):

Don't have pets






















Others would describe you as:    Yes                           No 





































 High Energy



 High Maintenance









 Low Maintenance































































Your scene:                            Yes                       No 







 Blue Collar



 Circuit Party









 Gym Bunny


























Your favorite cuisines:           Yes                       No 














































 Middle Eastern






 Soul food



 South American
































Your favorite music:                    Yes                No  




 Big Band/Swing









 Classic Rock n' Roll















 Easy listening



 Heavy Metal









 Modern Rock 'n Roll



 New Age









 Pop/Top 40



 Rap/Hip hop






 Show tunes






 World music




You like to read:        Yes                  No                 
















 Trade Journals





Your favorite movie genres:      Yes             No