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2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Email
14. Phone
15. Preferred Method of Contact
    -- Select One --EmailPhone
17. How did you find out about Veterans' Voices
19. Where do you usually watch Veterans Voices
    -- Select One --HomeWorkSchoolOther*
20. *Other
    If answer to previous question is other please explain.
22. When are you most likely to watch an episode of Veterans Voices?
24. How do you watch Veterans Voices?

    Check all that apply

    1. I watch it live
    2. I catch a re-run episode, later in the month
    3. I DVR or Tivo it

    1. I watch it live on my laptop or mobile device
    2. I watch previous episodes on my laptop or mobile device
26. Why do you watch the show?

    Check all that apply

    1. I am a veteran
    2. I have a family member who sevrved
    3. I know someone who served

    1. I find it interesting and I want to learn more about the topics discussed
    2. Other*
28. *Other - Please elaborate
30. Are you a Veteran?
    -- Select One --YesNo
31. Service Period Begining
    -- Select One --1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016
32. Service Period Ending
    -- Select One --1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016Present
33. Conflicts Served
35. Gender
    -- Select One --MaleFemaleOtherDecline to State
36. Other Gender
37. Age

    1. 18 - 29
    2. 30 - 49

    1. 50 - 69
    2. 70 or over
39. Do you use social media?
    -- Select One --YesNo
41. Please check all social media you use

    1. Facebook
    2. Twitter
    3. Linkedin
    4. Google+

    1. Youtube
    2. Instagram
    3. Tumblr
    4. Flikr

    1. Vine
    2. Reddit
    3. Pintrest
    4. Next Door
43. Thank you for joining the Viewer Advisory Panel. We appreciate your interest in helping to improve the show. You can expect to receive a SHORT Email survey after each monthly episode airs. If you cannot watch the show live, plan to view it on a later rebroadcast (3 times per week) or on our website."
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45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

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