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Sweepstakes Drawing, Email Address (Optional) Please Fill out the Form on the Left Non-HispanicPages1-2 4/21/05 6:13 AM Page 1 National Consumer Survey www.SimmonsSurvey.com THANKS FOR TAKING PART IN THIS IMPORTANT CONSUMER SURVEY. AKESKLET ST RM AND $2,000OMPLETED BOO OMPLETEOUR THIS CO WIN FO $2,000!! SY! C ’S EA IT ONG WITH Y SWEEPOUR CHANCE T R Y MAIL ITFO AL Name If you have any questions about the Simmons National Consumer Survey, Address please call 1-800-551-6425, or visit our website at www.SimmonsSurvey.com. We will be pleased to help you. City This is your opportunity to tell businesses and advertisers about the State products you like and the types of media you prefer. PLEASE MAKE YOUR OPINIONS COUNT BY Zip Code COMPLETING THIS BOOKLET. Your survey starts on Page 4. Phone Number If you would like to be entered into the $2,000 Sweepstakes drawing, Email Address (Optional) please fill out the form on the left. Non-HispanicPages1-2 4/21/05 6:13 AM Page 2 National Consumer Survey www.SimmonsSurvey.com Sweepstakes Official Rules 1. NO PURCHASE NECESSARY. To enter, neatly complete the front of this form (including your name and complete address) and return completed booklet in the enclosed postage paid envelope. One entry per person. No mechanically produced entries will be accepted. Sweepstakes begins May 21, 2005, and your entry must be received by the date on the front cover of this booklet. 2. On or about October 31, 2005, AKES winners will be selected in a random drawing from among all eligible entries ST received by Simmons Market Research Bureau, Inc. Simmons decisions concerning $2,000 the sweepstakes are final. 3. Sweepstakes is open to people living in the U.S., SWEEP aged 18 and older except employees, and members of their families living in the same household, of Simmons Market Research Bureau, Inc., its parent company and its subsidiaries, affiliates, brokers, distributors, retailers and advertising, promotion and production agencies. Void where prohibited. 4. (1) Grand Prize — $2,000 (two thousand dollars). Taxes and all other expenses are the responsibility of the winner. Odds of winning depend on the number of eligible entries received. 5. One prize per person, address or household. Sponsor not responsible for late, lost, stolen or misdirected mail or entries. No cash substitutions, transfers or assignments of prizes allowed, except by Sponsor for reason of unavailability, in which case a prize of equal or greater value will be awarded. Each prize winner must execute an affidavit of eligibility and liability/publicity release, which must be returned within fifteen (15) days of prize notification attempt or prize will be forfeited and an alternate winner will be selected. 6. For the names of the prize winners (available after October 31, 2005), send a self-addressed, stamped envelope to: Simmons Market Research Bureau, Inc. A National Marketing Research Firm 700 West Hillsboro Boulevard Suite 4-201 Deerfield Beach, FL 33441-1620 Attention: NCS PRIZE LIFESTYLE Lifestyle 1 SPORTS & FITNESS EVENTS Here are some events that people experience. Please mark the box for each of the events Please mark the sports in which you played or participated in the last 12 months. you experienced in the last 12 months and also mark those which you expect to expe- For each sport marked, please indicate how often you played or participated rience within the next 12 months. during the last 12 months. Experienced Expect in to in Participated in Last 12 Months Last 12 Next 12 Event Months Months Played or Every Participated in Chance Last 12 Months I Get Occasionally Seldom Graduation from School □ □ Basketball □ □ □ □ Change job - to better job □ □ Baseball □ □ □ □ Change job - same level/ pay □ □ Football □ □ □ □ Change job - lower level/ pay □ □ Hockey □ □ □ □ Change job - to something different □ □ Soccer □ □ □ □ Lose job - laid off/ went out of business □ □ Softball □ □ □ □ Buy first home □ □ Volleyball □ □ □ □ Buy new home (not first home) □ □ Golf □ □ □ □ Refinancing your home □ □ Tennis □ □ □ □ First time financial investment □ □ Racquetball □ □ □ □ Get married □ □ Billiards/ Pool □ □ □ □ Separated/ Divorced □ □ Bowling □ □ □ □ Make major home improvement □ □ Ice Skating □ □ □ □ Sell or change home □ □ In-line Skating/ Roller Skating □ □ □ □ Buy a used car or light truck □ □ Skateboarding □ □ □ □ Lease or buy new car or light truck □ □ Snowboarding □ □ □ □ First child is born □ □ Snowmobiling □ □ □ □ Second child is born □ □ Downhill/ Cross Country Oldest child enters school □ □ Snow Skiing □ □ □ □ Child enters college □ □ Water Skiing □ □ □ □ Youngest child graduates college □ □ Jet Skiing/ Wave Running/ Youngest child leaves home □ □ Water Biking □ □ □ □ Youngest son gets married □ □ Skin Diving/ Snorkeling □ □ □ □ Youngest daughter gets married □ □ Swimming □ □ □ □ Make last home mortgage payment □ □ Surfing/ Windsurfing □ □ □ □ Grandchild is born □ □ Power Boating □ □ □ □ Retire or take early retirement □ □ Sailing □ □ □ □ Collect lump sum from company pension, Canoeing/ Kayaking □ □ □ □ savings or stock plan □ □ Fly Fishing □ □ □ □ Death in the Family □ □ Fresh Water Fishing □ □ □ □ None of these □ □ Salt Water Fishing □ □ □ □ Horseback Riding □ □ □ □ PHYSICAL FITNESS PROGRAMS Hunting □ □ □ □ Have you engaged in a regular exercise program in the last 12 months where Target Shooting □ □ □ □ you exercised strenuously, either at home or elsewhere? Archery □ □ □ □ Backpacking/ Hiking □ □ □ □ Yes No Camping Trips (Overnight) □ □ □ □ □ □ Mountain/ Rock Climbing □ □ □ □ IF YES Fitness Walking/ Exercise/ Walking □ □ □ □ Where do you exercise? Jogging/ Running □ □ □ □ At Home □ Aerobics □ □ □ □ At Private Club □ Karate/ Martial Arts/ Kickboxing □ □ □ □ At YMCA/ YWCA □ Weight Training □ □ □ □ Other Facility □ Yoga □ □ □ □ Bicycling - Stationary □ □ □ □ How many times a week do you exercise? Bicycling - Mountain/ Road □ □ □ □ 5 or more □ Rowing - Stationary/ Outdoor □ □ □ □ 3 - 4 □ Use Cardio Machines □ □ □ □ 2 □ Motorcycling □ □ □ □ 1 □ Auto Racing or Rallying □ □ □ □ None □ Other Sports □ □ □ □ None of These □ 4 1 Lifestyle MEMBERSHIPS LIVE THEATER/ CONCERTS/ DANCE CASINO GAMBLING Have you visited a casino in the last 12 months? To which, if any, of the following do you belong? Thinking only about professional music, dance or Yes No theater performances by nationally or regionally known □ □ A Body of Local Government □ performers or groups, what have you attended in the IF YES American Association of Retired last 12 months: Number of visits in the last 12 months: Persons (AARP) □ Yes No Arts Associations (Museum, Symphony, More than 10 times Comedy Club □ □ □ Opera, Dance) □ 6 - 10 times Concert □ □ □ Business Clubs (such as Jaycees, Chamber Dance Performance 3 - 5 times □ of Commerce) □ □ □ Live Theater 1 - 2 times □ Church/ Temple/ Synagogue □ □ □ Church Board □ Where did you visit a casino in the IF YES Civic Clubs (such as Kiwanis, Lions, Rotary) □ last 12 months? Country Club How many times did you attend in the □ Atlantic City □ Environmentalist Organization last 12 months? (For each type you attended) □ The Caribbean Islands □ Fraternal Orders (such as Elks, Masons, Times in Last 12 Months Cruise Ships □ Eastern Star) □ 5 or more 3-4 1-2 Europe □ Hospital Board □ Comedy Club □ □ □ Indian Reservation □ Human Rights Organization (Amnesty Concert - Classical Las Vegas Int., ACLU, etc.) □ □ □ □ □ Concert - Country Laughlin PTA/ Parents Association □ □ □ □ □ Concert - Rock/ Pop Mississippi’s Gulf Coast (Gulfport/ Biloxi) Regional Development Committee □ □ □ □ □ Religious Clubs (such as Hadassah, Knights Dance Performance □ □ □ Reno/ Lake Tahoe □ of Columbus) □ Live Theater □ □ □ Riverboat □ School or College Board □ Tunica (MS) □ Union □ COLLECTING & COLLECTIBLES Other □ Veterans Clubs (such as V.F.W., American Legion) □ Please mark which of the following items you None of These □ personally collect. Then mark the items you STATE LOTTERY purchased for yourself or as a gift for someone else in the Have you purchased any state Yes No LEISURE ACTIVITIES/ HOBBIES last 12 months. lottery tickets in the last 12 months? □ □ Bought in Last Please mark the leisure activities or hobbies in 12 Months IF YES How often did you purchase tickets in the which you participated in the last 12 months. Personally For As A Collect Self Gift last 12 months? Antique Shopping/ Shows □ Animation Art (Collectible More than once a week Bird Watching □ Animation Cells) □ □ □ □ Once a week Board Games □ Antique Toys □ □ □ □ 2 or 3 times a month Card Games □ Coins (Numismatic) □ □ □ □ Once a month Cooking for Fun □ Cottages/ Houses (Porcelain) □ □ □ □ Less than once a month Dining Out (Not Fast Food) □ Crystal Figures/ Objects □ □ □ □ Education Courses □ Decorative/ Commemorative/ Types played in last 12 months and last 30 days: Limited Edition Plates Gardening □ □ □ □ Die-Cast/ Miniatures Cars □ □ □ Last 12 Last 30 Go Carting □ Months Days Other Miniatures □ □ □ Going to Bars/ Nightclubs/ Dancing □ Daily Drawing □ □ Disney (Particular Character Going to a Beach/ Lake □ Instant Game □ □ or Theme Park) □ □ □ Listening to Music □ Weekly Drawing □ □ Dolls (Collectible Type) □ □ □ Needlework/ Quilting □ Ornaments □ □ □ Painting, Drawing, Sculpting □ Paper Collectibles (Comic ARMED FORCES Photography □ Books, Postcards, etc.) □ □ □ Playing Bingo □ Porcelain Figurines □ □ □ Have you ever served in the Yes No Playing a Musical Instrument □ Sports Memorabilia/ United States armed forces? □ □ Reading Books □ Trading Cards □ □ □ Reading Comics □ Stamps □ □ □ Are you currently serving on Yes No Reading Gaming Magazines □ Warner Bros., active
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