How old are you?

Please Select: 14 years and under 15 – 20 years 21 – 25 years 26 – 30 years 31 - 35 years 36 years and over

Where did you purchase Curl Magazine from?

How many others have read the magazine?

Please Select: 0 – 5 6 – 10 11 – 15 16 – 20 21 or more

What other surf magazines do you read or buy?

How often do you visit www.curl.co.nz?

Please Select: At least twice a week Once a week Fortnightly Once a month

How often do you surf?

Please Select: At least twice a week Once a week Fortnightly Once a month Occasionally

How often do you purchase something from a surf retail store?

Please Select: more than once a week once a week once a fortnight Monthly Less than monthly

How often do you buy new beauty product?

Please Select: more than once a week once a week once a fortnight Monthly Less than monthly

What is your household combined income? (including your partner, flatmates etc)

Please Select: Less than $40,000 $40,000 - $80,000 $80,000 - $150,000 $150,000 - $250,000 $250,000 and above

Do you intend to travel overseas in the next 12 months?

Please Select: Yes No Maybe

Do you ski or snowboard?

Please Select: Yes No

Do you skate?

Please Select: Yes No

In the next 12 months do you intend to buy?

---

and lastly fill in your name and details to make sure you're in the draw!

---

Your First Name:

Your Last Name:

Your Email Address:

Your Cell Phone Number:


Your Address
Street:

Suburb

City/Town:

Country: