1.	Please enter your email address*

2.	Gender:*
	Male  Female

3.	Age:*
	--Please Select--22 - 2425 - 3031 - 4041 - 5051 - 6060+

4.	Approximate weight:*
	--Please Select--<= 100101 - 125126 - 150151 - 175176 - 200201 - 225226 - 250251 - 275>= 276

5.	What was the last level of education you completed?*
	--Please Select--High SchoolCollegeUniversityNeither

	Please answer the following True or False questions.

6.	I smoke or use tobacco products.*
	True  False

7.	I have no problem telling a companion that he or she has done something to hurt my feelings.*
	True  False

8.	I often feel so restless I can't sit still.*
	True  False

9.	When I drink 7 or more drinks, I become aggressive.*
	True  False

10.	I like people who are sharp and witty even though they may sometimes hurt other peoples' feelings.*
	True  False

11.	When the alcohol runs out, I leave the party.*
	True  False

12.	When I make plans, I am almost certain to make them work.*
	True  False

13.	I have relatives who have had problems with alcohol or drugs.*
	True  False