Thank you for your interest in taking part in Question Time.Would you please fill in the following details. Your response will be completely confidential, but they will enable us to invite a representative cross-section of people.
1. Name and address
Full name: Your address: Your Postcode:
Your Phone number: Daytime Evening Mobile Fax
Email address:
2. Have you been on Question Time before? Yes No
If yes, when? Month January February March April May June July August September October November December Year 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
3. How old are you? 16-24 25-34 35-44 45-54 55-64 65+
4. What is your occupation?
5. Which of the following categories best describes your occupation? Senior Management Middle/Jnr. Management Clerical/Administration Skilled Manual Unskilled Manual Student Housewife Unemployed
6. During the series, we shall be visiting London and various cities and towns around the country. Would you please name the venues most convenient for you.
7. If there were a General Election tomorrow, which political party would you be most likely to vote for? Conservative Labour Liberal Democrats Green Scottish National Plaid Cymru Ulster Unionist Democratic Unionist Sinn Fein Social Democrat & Labour Alliance Would not vote Undecided Other (please state)
8. Which of these groups do you consider yourself to belong to? White West Indian Indian Pakistani Chinese African Mixed Origin Other (please specify)
9. Do you consider yourself to have any disabilities? Yes No 10. If you are disabled, do you require wheelchair access? Yes No 11. Are you a member of a political party? Yes No 12. You will be invited to put forward two questions. Would you please confirm that you are willing to participate. Yes No
