Before you are included in the Meal Panel we first need a few details. Please answer these 13 short questions.
(Be assured your data will remain totally confidential to us)


1. First Name (only)            Surname    


2. Gender   

 Male   Female  


3. Postal Address (so we can mail you payment)     


4. Suburb / City       


5. State   

 NSW    VIC    QLD    SA    WA    TAS    ACT   NT   



6. Postcode      


7. Email Address (so we can contact you)      


8. Your age    

 Under 15 yrs   15 - 19   20 - 24   25 - 29   30 - 39   40 - 49   50 - 59   60 - 69   70 - 79   80 +  



9. Which ONE best describes your household?   

  Single living alone    Single with children    Sharing with other adults   
       Couple with children   Couple with no children (at home)  



10. Are you the main grocery buyer for the household?   

 Yes   No  



11. Which of these best describes you...   

 In full time paid employment   In part time paid employment   Self employed   Looking for employment   
        Not in the paid labour force (eg home duties)   Retired  



12. When out of the home, how often do you buy any snacks, meals, take-away food, coffee/tea or other non-alcoholic drinks ...   
(NOT including cigarettes, lollies, gum, beer, wine)

 Most days   Once or twice a week   Once or twice a month   Only on special occasions   Never / very rarely  


13. Enter the five digit CODE you were given by the Meal Panel Member who referred you      


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