name and email address?
             

      question or comment
      

      other demographics (optional) - (this helps me know who is interested in my blogs)

      where are you from?  (city, state, country?)

      are you a student? yes    no    decline

      what is your highest level of education?
       junior high student                    high school student              high school graduate
       college student                         AS/AA degree                     BS/BA degree       
       masters student or studies      MS/MA/MBA degree          MDiv degree
       doctoral student or studies      PhD/MD/EdD/ThD etc. degree
       decline

      what is your major? 

      what is your profession? 

      what is your gender? female    male    decline

      age group?
       younger than 13
       13 thru 15       16 thru 18       19 thru 22       22 thru 29
       30 thru 39       40 thru 49       50 thru 59       older than 59
       decline to answer!