Background Information Questionnaire

This questionnaire helps us to determine the relevance of questions answered and the background of the person answering the questions.

Please complete as many questions as you can, but feel free to leave out any questions you do not wish to answer.  All information gathered will only be used for statistical and communication purposes.  No personal information will be passed on to 3rd parties.

(we will not pass this information on to any 3rd parties)
This is optional, but we will be using it do reduce costs by not posting paper copies to those who complete their questionnaires.
This information will ONLY be used for us to send you further information and updates, should you require them.

So that we can see the spread of population in our village how many people in each of the following age groups live in your home?

Male:

Female:

Your history in the village?

Please tick all that apply
East = Up to St Nicholas Church
Central = Between St Nicholas Church and The Royal Legion Club
West = from The Royal Legion Club to Southend boundary