Vaccine Survey

Question Title

* 1. What is your age group?

18 to 30 years

31 to 50 years

51 to 70 years

Over 70 years

Question Title

* 2. Please select one statement below which best applies to you:

I have received the 1st dose and 2nd dose of the COVID- 19 vaccine

I have received the 1st dose of the COVID-19 vaccine and I am waiting for the 2nd dose of the COVID- 19 vaccine; or have made an appointment to receive the 1st dose of the COVID-19 vaccine

I intend and plan to receive the COVID- 19 vaccine

I am not planning to receive the COVID- 19 vaccine

I am not willing to disclose information relating to my intention or situation on receiving the COVID -19 vaccine

Question Title

* 3. In your opinion, what could Government do to encourage more people to take the vaccine?
Select any that apply.

Ease of travel

Reduced quarantine

Exemption from weekly testing

Financial incentives

Loosening of restrictions

Other :

Vaccine Survey

Question Title

* 1. What is your age group?

Question Title

* 2. Please select one statement below which best applies to you:

Question Title

* 3. In your opinion, what could Government do to encourage more people to take the vaccine? Select any that apply.

Question Title

* 4. What suggestions would you have to encourage fellow members and / or employees to get vaccinated allowing the Club to open further?

* 3. In your opinion, what could Government do to encourage more people to take the vaccine?
Select any that apply.