* First:		* Last:
* Age:		* Gender:
Orientation:
Email:
* Address 1:
Address 2:
* City:		* State:	Zip:
Home Phone:		Work Phone:
Cell Phone:
Employment Status:		Industry:
Ethnicity:		Marital Status:
Education:		Ed. Other:
Occupation:		Job Title:
Own/Rent:		Income Range:
Child #1 Age:		Child #2 Age:	Child #3 Age:
Child #4 Age:		Child #5 Age:
Comments:

Tobacco
User	Brand	Menthol	Stop Date yyyy-mm-dd

Vehicle
Own	Make	Model	Year

Computer
Own	Purchase Date yyyy-mm-dd	Brand