Brainsights Events Registration Questionnaire: Madrid

Please complete the following questions, to the best of your ability.

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Date of Birth (MM/DD/YYYY)

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* 5. Gender

Male

Female

Would prefer to specify

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* 6. Ethnicity

African

White/Caucasian

Black

Filipino

Arab

Latin, Central or South American

Japanese

Korean

Chinese

Vietnamese

West Asian (Afghan, Iranian, etc.)

East Asian (Cambodian, Malaysian, Indonesian, etc.)

South Asian (East Indian, Pakistani, etc.)

Indian

West Indian (Caribbean Islander)

Prefer not to answer

Other (please specify)

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* 7. Birthplace (City, Country)

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* 8. I have children in the following age ranges (select all that apply):

No Children

Currently Expecting

Newborn - 4 years

5 - 7 years

8 - 11 years

12 - 16 years

17+ years

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* 9. Do you own a car?

Yes

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* 10. If you own a car, please enter the make/model of any cars you own. If you don't own a car, please enter NA.

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* 11. Have you purchased a car in the last 12 months?

Yes

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* 12. Do you intend to purchase a car in the next 12 months?

Yes

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* 13. What is your gross annual household income?

Less than €20,000

€20,000 – €49,999

€50,000 – €80,000

More than €80,000

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* 14. Which best describes your employment status?

Student

Unemployed / Looking for work

Part time

Full time

Homemaker / Stay-at-home parent

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* 15. What is your impression of the following brands?

	1 - Strongly dislike	2 - Dislike	3 - Somewhat dislike	4 - Neutral or no opinion	5 - Somewhat like	6 - Like	7 - Strongly like	I've never heard of this brand
Seat	Seat 1 - Strongly dislike	Seat 2 - Dislike	Seat 3 - Somewhat dislike	Seat 4 - Neutral or no opinion	Seat 5 - Somewhat like	Seat 6 - Like	Seat 7 - Strongly like	Seat I've never heard of this brand
Nissan	Nissan 1 - Strongly dislike	Nissan 2 - Dislike	Nissan 3 - Somewhat dislike	Nissan 4 - Neutral or no opinion	Nissan 5 - Somewhat like	Nissan 6 - Like	Nissan 7 - Strongly like	Nissan I've never heard of this brand
Dacia	Dacia 1 - Strongly dislike	Dacia 2 - Dislike	Dacia 3 - Somewhat dislike	Dacia 4 - Neutral or no opinion	Dacia 5 - Somewhat like	Dacia 6 - Like	Dacia 7 - Strongly like	Dacia I've never heard of this brand
Renault	Renault 1 - Strongly dislike	Renault 2 - Dislike	Renault 3 - Somewhat dislike	Renault 4 - Neutral or no opinion	Renault 5 - Somewhat like	Renault 6 - Like	Renault 7 - Strongly like	Renault I've never heard of this brand
Volkswagen	Volkswagen 1 - Strongly dislike	Volkswagen 2 - Dislike	Volkswagen 3 - Somewhat dislike	Volkswagen 4 - Neutral or no opinion	Volkswagen 5 - Somewhat like	Volkswagen 6 - Like	Volkswagen 7 - Strongly like	Volkswagen I've never heard of this brand
Peugeot	Peugeot 1 - Strongly dislike	Peugeot 2 - Dislike	Peugeot 3 - Somewhat dislike	Peugeot 4 - Neutral or no opinion	Peugeot 5 - Somewhat like	Peugeot 6 - Like	Peugeot 7 - Strongly like	Peugeot I've never heard of this brand
Citroen	Citroen 1 - Strongly dislike	Citroen 2 - Dislike	Citroen 3 - Somewhat dislike	Citroen 4 - Neutral or no opinion	Citroen 5 - Somewhat like	Citroen 6 - Like	Citroen 7 - Strongly like	Citroen I've never heard of this brand
Ford	Ford 1 - Strongly dislike	Ford 2 - Dislike	Ford 3 - Somewhat dislike	Ford 4 - Neutral or no opinion	Ford 5 - Somewhat like	Ford 6 - Like	Ford 7 - Strongly like	Ford I've never heard of this brand
Hyundai	Hyundai 1 - Strongly dislike	Hyundai 2 - Dislike	Hyundai 3 - Somewhat dislike	Hyundai 4 - Neutral or no opinion	Hyundai 5 - Somewhat like	Hyundai 6 - Like	Hyundai 7 - Strongly like	Hyundai I've never heard of this brand
Opel	Opel 1 - Strongly dislike	Opel 2 - Dislike	Opel 3 - Somewhat dislike	Opel 4 - Neutral or no opinion	Opel 5 - Somewhat like	Opel 6 - Like	Opel 7 - Strongly like	Opel I've never heard of this brand
Toyota	Toyota 1 - Strongly dislike	Toyota 2 - Dislike	Toyota 3 - Somewhat dislike	Toyota 4 - Neutral or no opinion	Toyota 5 - Somewhat like	Toyota 6 - Like	Toyota 7 - Strongly like	Toyota I've never heard of this brand
Kia	Kia 1 - Strongly dislike	Kia 2 - Dislike	Kia 3 - Somewhat dislike	Kia 4 - Neutral or no opinion	Kia 5 - Somewhat like	Kia 6 - Like	Kia 7 - Strongly like	Kia I've never heard of this brand

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* 16. Would you consider purchasing any of the following brands in the future?

	1 - Definitely would not consider	2 - Probably would not consider	3 - Not sure	4 - Might consider	5 - Definitely would consider
Seat	Seat 1 - Definitely would not consider	Seat 2 - Probably would not consider	Seat 3 - Not sure	Seat 4 - Might consider	Seat 5 - Definitely would consider
Nissan	Nissan 1 - Definitely would not consider	Nissan 2 - Probably would not consider	Nissan 3 - Not sure	Nissan 4 - Might consider	Nissan 5 - Definitely would consider
Dacia	Dacia 1 - Definitely would not consider	Dacia 2 - Probably would not consider	Dacia 3 - Not sure	Dacia 4 - Might consider	Dacia 5 - Definitely would consider
Renault	Renault 1 - Definitely would not consider	Renault 2 - Probably would not consider	Renault 3 - Not sure	Renault 4 - Might consider	Renault 5 - Definitely would consider
Volkswagen	Volkswagen 1 - Definitely would not consider	Volkswagen 2 - Probably would not consider	Volkswagen 3 - Not sure	Volkswagen 4 - Might consider	Volkswagen 5 - Definitely would consider
Peugeot	Peugeot 1 - Definitely would not consider	Peugeot 2 - Probably would not consider	Peugeot 3 - Not sure	Peugeot 4 - Might consider	Peugeot 5 - Definitely would consider
Citroen	Citroen 1 - Definitely would not consider	Citroen 2 - Probably would not consider	Citroen 3 - Not sure	Citroen 4 - Might consider	Citroen 5 - Definitely would consider
Ford	Ford 1 - Definitely would not consider	Ford 2 - Probably would not consider	Ford 3 - Not sure	Ford 4 - Might consider	Ford 5 - Definitely would consider
Hyundai	Hyundai 1 - Definitely would not consider	Hyundai 2 - Probably would not consider	Hyundai 3 - Not sure	Hyundai 4 - Might consider	Hyundai 5 - Definitely would consider
Opel	Opel 1 - Definitely would not consider	Opel 2 - Probably would not consider	Opel 3 - Not sure	Opel 4 - Might consider	Opel 5 - Definitely would consider
Toyota	Toyota 1 - Definitely would not consider	Toyota 2 - Probably would not consider	Toyota 3 - Not sure	Toyota 4 - Might consider	Toyota 5 - Definitely would consider
Kia	Kia 1 - Definitely would not consider	Kia 2 - Probably would not consider	Kia 3 - Not sure	Kia 4 - Might consider	Kia 5 - Definitely would consider

Other (please specify)

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* 17. How well do each of the following statements align with you as a person?

	1 - Strongly disagree	2 - Somewhat disagree	3 - Neither agree nor disagree	4 - Somewhat agree	5 - Strongly agree
I consider myself to be environmentally responsible/conscious	I consider myself to be environmentally responsible/conscious 1 - Strongly disagree	I consider myself to be environmentally responsible/conscious 2 - Somewhat disagree	I consider myself to be environmentally responsible/conscious 3 - Neither agree nor disagree	I consider myself to be environmentally responsible/conscious 4 - Somewhat agree	I consider myself to be environmentally responsible/conscious 5 - Strongly agree
I live life to the fullest	I live life to the fullest 1 - Strongly disagree	I live life to the fullest 2 - Somewhat disagree	I live life to the fullest 3 - Neither agree nor disagree	I live life to the fullest 4 - Somewhat agree	I live life to the fullest 5 - Strongly agree
I like to eat healthy and take care of myself	I like to eat healthy and take care of myself 1 - Strongly disagree	I like to eat healthy and take care of myself 2 - Somewhat disagree	I like to eat healthy and take care of myself 3 - Neither agree nor disagree	I like to eat healthy and take care of myself 4 - Somewhat agree	I like to eat healthy and take care of myself 5 - Strongly agree
I often think about the feelings and needs of others	I often think about the feelings and needs of others 1 - Strongly disagree	I often think about the feelings and needs of others 2 - Somewhat disagree	I often think about the feelings and needs of others 3 - Neither agree nor disagree	I often think about the feelings and needs of others 4 - Somewhat agree	I often think about the feelings and needs of others 5 - Strongly agree
I rarely go out with friends, and it doesn't bother me	I rarely go out with friends, and it doesn't bother me 1 - Strongly disagree	I rarely go out with friends, and it doesn't bother me 2 - Somewhat disagree	I rarely go out with friends, and it doesn't bother me 3 - Neither agree nor disagree	I rarely go out with friends, and it doesn't bother me 4 - Somewhat agree	I rarely go out with friends, and it doesn't bother me 5 - Strongly agree
I rarely consider the impact of my choices on the environment	I rarely consider the impact of my choices on the environment 1 - Strongly disagree	I rarely consider the impact of my choices on the environment 2 - Somewhat disagree	I rarely consider the impact of my choices on the environment 3 - Neither agree nor disagree	I rarely consider the impact of my choices on the environment 4 - Somewhat agree	I rarely consider the impact of my choices on the environment 5 - Strongly agree
I'm the last person that would organize an event with friends or my community	I'm the last person that would organize an event with friends or my community 1 - Strongly disagree	I'm the last person that would organize an event with friends or my community 2 - Somewhat disagree	I'm the last person that would organize an event with friends or my community 3 - Neither agree nor disagree	I'm the last person that would organize an event with friends or my community 4 - Somewhat agree	I'm the last person that would organize an event with friends or my community 5 - Strongly agree
I try to make lifestyle choices that are socially responsible and respect the environment	I try to make lifestyle choices that are socially responsible and respect the environment 1 - Strongly disagree	I try to make lifestyle choices that are socially responsible and respect the environment 2 - Somewhat disagree	I try to make lifestyle choices that are socially responsible and respect the environment 3 - Neither agree nor disagree	I try to make lifestyle choices that are socially responsible and respect the environment 4 - Somewhat agree	I try to make lifestyle choices that are socially responsible and respect the environment 5 - Strongly agree

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