City you live in:

State you live in:

Age:

How many drinks on average do you consume a week? 0 1-3 4-6 6-8 8+

Where do you drink most often?    Home Work School Bar Other

Have you ever drove while being intoxicated?

Have you drove while intoxicated within the past month?

Do you know a friend that has drove while intoxicated ?

Do you know a friend that has drove while intoxicated in the past month?

Have you ever been injured in a traffic accident as a result of intoxicated driver?

Thank you for your time!!