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First Name:
Last Name:
Address:			Male Female
City:			State:	Zip:
Phone:			Email:

Create Password (8-15 characters):
Confirm Password:
Birthdate (mm/dd/yyyy):
Dine Out Frequency/wk:	1-5 6-10 10+
Coupons Important?:	Yes No
Coupons Influence Dining Choice?:	Yes No
Online Ordering Important?:	Yes No
Online Ordering Influence Choice?:	Yes No
Work Cater Food?:	Yes No
Favorite Restaurants?: