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Red Wine Preferences (Ctrl Click to select more than one)

Other Red Wine (Specify)

White Wine Preferences (Ctrl Click to select more than one)

Other White Wine (Specify)

Price Range (case of 6 bottles)

Purpose for buying Wine? (Ctrl Click to select more than one)

Where do you enjoy your wine most of the time? (Ctrl Click to select more than one)

Other beverage preferences (Ctrl Click to select more than one)

Eating Out Preferences (Ctrl Click to select more than one)

Cuisine Preferences (Ctrl Click to select more than one)

Music Preferences (Ctrl Click to select more than one)

Music Other (Specify)

Spa and Beauty Preferences (Ctrl Click to select more than one)

Spa and Beauty Other (Specify)

Art Preferences (Ctrl Click to select more than one)

Art Other (Specify)

Retail (Ctrl Click interested in any of the below)

Retail Interests Other (Specify)

Sports Interests (Specify)

Recreational Interests (Specify)

Do you have any Social Responsibilties? (Please Specify)