* Denotes required field
1. Name & Address
Title:	Mr.Mrs.Ms.Miss
First Name: *
Middle Initial:
Last Name: *
Address: *
Address 2:
City: *
State: *	-- Select a State -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Postal Code: *
Email Address:

2. Your date of birth:	-- Select a Month -- January February March April May June July August September October November December	-- Select a Year -- 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

3. Marital Status:	MarriedSingle

4. Date of purchase:

-- Select a Month -- January February March April May June July August September October November December -- Select a Day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- Select a Year -- 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

5. Product Name:

6. UPC code of the product you purchased: *
(Please include all 12 digits):

7. Name of store where purchased:

8. Price paid (excluding sales tax): $ .00

9. What are the top three (3) reasons influencing the purchase of your Kelty product?
Kelty ReputationRecommendation of Friend/Relative AdvertisingRecommendation of Salesperson ColorSafety Features DesignSaw Product in Use Ease of UseShape Good Fit/ComfortSize Insulation MaterialsSpecial Features of Product Item on Sale/Sale PriceStyle/Appearance LightweightValue for Price Met Important RequirementsWarranty Prior Experience with KeltyWebsite Quality/DurabilityOther Received as a Gift

10. Other than this purchase, which of the following brands of products do you currently own?

	Tents	Sleeping Bag	Backpack	Child Carrier	Airbed

Arx’Teryx Camp Trails Coleman Columbia Dana Designs Eddie Bauer Eureka Gregory Hillary Kelty Lowe Marmot Mountain Hardwear Mountainsmith Ozark Trail Patagonia Sierra Designs The North Face Wenzel None Other REI Osprey Nemo Vaude

11. Which of these products do you plan to purchase in the next 12 months?
AirbedHammock BackpackHydration System Backpacking TentOutdoor Fire Pit Cast Iron CookwareOutdoor Furniture Cooking SetScreenhouse DaypackSleeping Bag Dining CanopyTravelpack/Duffel Family Camping Tent

12. Where do you plan to shop/purchase any of the items listed above in question 11?
Specialty Outdoor StoreJuvenile Specialty Store General Sporting Goods StoreMail Order and Internet Mass Merchant Store

13. Which of the following magazines do you read on a regular basis? (3 out of the last 4 issues)
BackpackerOutdoor Life Camping LifeOutside ClimbingPowder Family FunSelf Field & StreamShape Hooked on OutdoorsSierra MaximSki Men’s HealthSkiing Men’s JournalSunset National Geographic AdventureTriathlete

14. A) What outdoor activities do you and your family frequently participate in together? (3 or more times per month)
WalkingTent Camping HikingCar Camping BackpackingSkiing CyclingIn-Line Skating Mountain BikingOther

B) Who inspired you to participate in these activities?
FriendChurch Group FamilyOuting Club ScoutsSchool Trip

C) Do you participate in any of these additional sport/recreation activities?
Attending Sporting EventsRV/Pop-up camping ATVScuba Diving Backpacking/HikingSnowboarding BowlingSnowmobiling ClimbingSnowshoeing Cross-country/Nordic skiingSwimming In-line skatingTeam sports Kayaking/CanoeingTelemark skiing Martial artsVideo/Computer games MotorcyclingWater skiing/Wake boarding Personal watercraftWorkout in gym Rafting

15. Not including yourself, what is the GENDER and AGE (in years) of children and other adults living in your household?
No one else in household Child Under 1 Year   1. MaleFemale Age: 2. MaleFemale Age: 3. MaleFemale Age: 4. MaleFemale Age:

16. Occupation: (check all that apply)

	You	Spouse

Professional/Technical Upper Management/Executive Middle Management Sales/Marketing Clerical/Service Worker Tradesman/Machine Operator/Laborer

17. Are you or your spouse:

	You	Spouse

A Homemaker? Retired? A Student? Self Employed/Business Owner? Working from a Home Office? In the Military? A Veteran?

18. Which group describes your annual family income?
Under $15,000$75,000-$99,999 $15,000-$19,999$100,000-$124,999 $20,000-$29,999$125,000-$149,999 $30,000-$39,999$150,000-$174,999 $40,000-$49,999$175,000-$199,999 $50,000-$59,999$200,000-$249,999 $60,000-$74,999$250,000 & over

19. Level of education: (select highest level completed)
Completed High SchoolCompleted Graduate School Completed College

20. Which credit cards do you use regularly?
American Express, Diners ClubDepartment Store, Oil Company, etc. MasterCard, Visa, DiscoverDo not use credit cards

21. For your primary residence, do you:
Own?Rent?

22. How recently did you move into your current residence?
Within 30 days7 to 12 months ago Within 1-3 monthsHave not moved in the last 12 months Within 4-6 months

23. Which of the following do you plan to do within the next 1-6 or 7-12 months? (select all that apply)

	1-6 Months	7-12 Months

Buy/Lease a New Vehicle Buy/Lease a Used Vehicle

24. Please check all that apply to your household.
Shop by Catalog/MailHave a Cat Shop via the InternetOwn a Wireless/Cellular Phone Member of Frequent Flyer ProgramSpeak Spanish Donate to Charitable CausesOwn an Apple/Macintosh Computer Own a Compact Disc PlayerOwn a CD-ROM Drive Have a Dog

25. To help us understand our customers' lifestyles, please indicate the interests and activities in which you or your spouse enjoy participating on a regular basis.
BicyclingPhotography GolfCultural/Arts Events Physical Fitness/ExerciseFashion Clothing Running/JoggingArt/Antique Collecting Snow SkiingForeign Travel TennisCruise Ship Vacations Camping/HikingTravel in USA FishingGourmet Cooking/Fine Foods Hunting/ShootingWines PowerboatingStamp/Coin Collecting SailingCollectibles GrandchildrenOur Nation’s Heritage Needlework/KnittingReal Estate Investments SewingStocks/Bond Investments Flower GardeningContests/Sweepstakes Vegetable GardeningCasino Gambling CraftsScience Fiction Buy Prerecorded VideosWildlife/Environmental Issues Automotive WorkDieting/Weight Control ElectronicsScience/New Technology Home Workshop/Do-It-YourselfSelf-Improvement Recreation Vehicles (RVs)Walking for Health Listen to Records/Tapes/CDsWatching Sports on TV Avid Book ReadingHome Video Recording Bible/Devotional ReadingMoneymaking Opportunities Health/Natural Foods

26. From the above list, please indicate your 3 most important activities:
1. 2. 3.

Your Privacy Rights

We collect personal information about our users only during product registration. The data we collect is used in the aggregate to give us demographic information about the entire audience registering their products. We use this to understand that audience and to improve our offerings to you, our customers.

Failure to submit this registration will not diminish your warranty rights.