Real Health Spring 2010: How Green is your World?

Just how green is your world? Take this survey and tell us how important protecting the Earth is to you and what you do to make a difference each day.
 
1. Name:
 
2. Organization (if you represent one):
 
3. Street address:
 
4. City & state:
 
5. Zip code:
 
6. E-mail:
 
7. Phone:
 
8. What year were you born? (e.g., 1975)
 
9. What is your gender?
Female
Male
Transgender
Other
 
10. What is your household income?
Under $15,000
$15,000–$34,999
$35,000–$49,999
$50,000–$74,999
$75,000–$99,999
$100,000 and over
 
11. What is the highest level of education attained?
Some high school
High school graduate
Some college
Bachelor's degree or higher
 
12. What is your ethnicity
American Indian or Alaska Native
Arab or Middle Eastern
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Other
 
13. Where do you get Real Health?
I'm a subscriber
My doctor's office
My church
A community or college organization
It was mailed to my home or office
Other: (please specify): 
 
14. Do you have internet access?
Yes
No
 
15. How environmentally conscious are you?
Extremely
Somewhat
Not at all
 
16. What type of items do you recycle? (Check all that apply.)
Beverage cartons, bottles, cans, metals and foil
Paper products of all kinds (newspapers, magazines, etc.)
Clothing
Batteries
Small electrical goods (for example, cell phones)
Other: (please specify): 
 
17. How often do you donate or give away your used or unwanted possessions?
Always
Sometimes
Never
 
18. How often do you purchase environmentally friendly products?
Always
Sometimes
Never
 
19. How often do you purchase products made from recyclable materials?
Always
Sometimes
Never
 
20. How often do you think about air pollution?
Always
Sometimes
Never
 
21. How concerned are you about global warming?
Extremely
Somewhat
Not at all