Customer Information
Name:
Address:
City, ST Zip:
E-mail:
	(I give my permission for Polar to contact me later)
Daytime Phone:	-
Age:	under 25 25 to 34 35 to 44 45 to 54 55 to 64 65 or over
Sex:	Female Male
Occupation:	Select one Administrative worker Full-time athlete Homemaker Manager Manufacturing/Production worker Professional Retired Self employed Student Other
	(specify it if Other)
Product Information
Model:
Serial Number:	(ie.H805190000001)
Month and year of purchase:	Select Month 1 2 3 4 5 6 7 8 9 10 11 12 Select Year 1999 2000 2001 2002 2003 2004 2005 2006
Other Information
Did you:	receive the Heart Rate Monitor (HRM) as a gift?
	purchase the HRM yourself
	Others (specify it)
What is your primary reason for using a HRM?	Select one Competetive athletics Recreational athletics Improve and maintain overall fitness Weight management Manage stress Cardiac rehabilitation Other
	(specify it if Other)
Where do you primarily use the HRM?	Select one At home (indoors) Outdoors In health/fitness center In rehabilitation center Elsewhere
	(specify if Elsewhere)
What are your primary activities? (choose up to three; hold the "control" key to select more than one.)	Running Cycling Mountain biking Triathlon/Duathlon Walking Swimming Exercise with indoor equipment Group exercise/Aerobics Circuit or weight training Soccer American footbal/Rugby/Australian rules Ice hockey Basketball Volleyball Other team sports Racket sports Winter sports
	(specify it if Other)
On average, how many hours per week do you exercise or participate in sports?	1-3 7-9 4-6 10 hrs or more
How often do you use your HRM when exercising/participating in sports?	Always Almost always Occasionally Seldom Never
Did you previously own another heart rate monitor?	No Yes, Polar HRM Yes, other:
Please choose the 3 most important reasons why you selected this product: (choose only three; hold the "control" key to select more than one.)	Polar reputation (Global) service availability Style/Appearance Quality Product Features Ease of use
	(specify it if Other)
Approximate your total annual household income:	Under $30,000 $30,000 to $49,000 $50,000 to $99,000 $100,000 and above
How did you learn about heart rate monitoring and Polar HRMs? (choose all that apply: hold the "control" key to select more than one.)	Magazine/Newspaper ads Fitness/Health/Sports Articles Salesperson Friend Medical recommendation Coach/Trainer Television Radio Sports event or trade show Polar literature In store display (or product brochures) Internet
	(specify it if Other)
Type of store where purchased:	Select one General sporting goods store Fitness equipment store Bicycle shop Running store Outdoor retailer Department store Health store Fitness club Watch shop/Jeweler Catalog/Mail order Internet Other
	(specify it if Other)