Cannabis Consumers Participant Survey - Form EZPlease complete as much of this survey as possible. Don't answer the items that you don't care to or that do not apply. The information you provide in this survey may be used on our web site or in other public education materials to portray a more accurate and positive image of cannabis consumers. Your personal contact information will not be released without prior permission. Thank you. | |
| Last Name: | |
| EMail: | |
| Street: | |
| City: | |
| State: | Zip: - |
| Country: | |
| Phone: | |
| Date of birth: | / / (MM/DD/YY) |
| Education: | High school Some college College grad Post grad |
| Degree(s): | |
| Credentials, certifications or licenses: | |
| Occupation / Job title: | |
| Special interests, hobbies, talents: | |
| Important accomplishments, awards, honors, contributions to society or your community: | |
| When did you first use cannabis? (age/year) | |
| Would you prefer to state that you have used or that you do use it? | |
| Statement about your cannabis use: (Why do you like it, how does it enhance your life, how do you consume it, which varieties, how often?): | |
| Release of liability: I hereby give permission to use my information and release Mikki Norris, Cannabis Consumers Campaign, Pot Pride, and sponsoring organizations from any liability whatsoever from any cause or reason, in con-nection with the release, dissemination and publication of statements and information that I have provided here. | |
| Take our survey and participate in the Cannabis Consumers Campaign. |