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First Name
Last Name
Email
Username (Nickname on site)
Password
Password Confirm
Address Line 1
Address Line 2
City
State
-- choose State --
Alabama
Alaska
American Samoa
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Connecticut
DC
Delaware
Florida
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Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
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Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Country
UNITED STATES
Mobile Phone
Please note:
HEYA is limited to residents of the United States only
Date of Birth
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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5
6
7
8
9
10
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29
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31
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
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1961
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1963
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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
Gender
(Select Gender)
Female
Male
Ethnicity
-- choose --
African American
Asian
Caucasian
Hispanic
Prefer not to answer
Multi or Other
Other :
Occupation
Do you work in any of the following fields?
-- select --
Advertising
Marketing
PR
None of the above
Marital Status
-- select --
Single
Co-habitating
Married
I prefer not to answer
Do you have kids?
Check this if you do have kids.
Do you mind telling us your household income? (optional)
-- choose --
0 - 20,000
20,001 - 50,000
50,001 - 100,000
100,000+
What is your T-Shirt size?
-- choose --
S
M
L
XL
How did you hear about HEYA?
-- choose --
Venus Zine
Website Advertisement
Toyota Communication
HEYA Event
Inhabitat
Friend
Facebook Flyer
Daily Candy
Ecospace
Other
Other :
Please specify the website :
ALL FIELDS ARE REQUIRED
1.
Do you have a driver's license?
yes
no
2.
Do you currently own a vehicle?
yes
no
What is the make/model year?
Year
(Select Year)
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
Car Make
-- choose --
Acura
Audi
BMW
Cadillac
Chevy
Chrysler
Dodge
Ford
Honda
Hummer
Jaguar
Jeep
Lexus
Land Rover
Lincoln
Mazda
Mercedes Benz
Mercury
Mini
Mitsubishi
Nissan
Oldsmobile
Porshe
Scion
Subaru
VW
Toyota
Volvo
Multi or Other
Other :
Car Model
Please select a make first
Other :
3.
Do you intend to purchase a vehicle in:
-- choose --
Less than 1 year
1-2 years
2-3 years
3 or more years.
I do not plan to purchase a vehicle.
What type of car would you consider purchasing/leasing?
New or used?
New
Used
2 Wheel Drive or 4 Wheel Drive?
2WD
4WD
How many doors?
-- choose --
Two
Three
Four
don't know
Car type?
-- choose --
car with trunk
station wagon
car with hatchback
convertible
truck
don't know
Type of engine?
-- choose --
Gasoline
Diesel
Hybrid
don't know
Size of engine?
-- choose --
4 cylinder
5 cylinder
V6
V8
V10+
don't know
What make or model are you considering for purchase/leasing for your next car?
Year
(Select Year)
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
Car Make
-- choose --
Acura
Audi
BMW
Cadillac
Chevy
Chrysler
Dodge
Ford
Honda
Hummer
Jaguar
Jeep
Lexus
Land Rover
Lincoln
Mazda
Mercedes Benz
Mercury
Mini
Mitsubishi
Nissan
Oldsmobile
Porshe
Scion
Subaru
VW
Toyota
Volvo
Multi or Other
Other :
Car Model
Please select a make first
Other :
4.
How would you rate your interest in cars/trucks?
-- choose --
1
2
3
4
5
(rate from 1-5, 1 being not very interested, 5 being very interested)
5.
Outside of your work, which of the following activities do you enjoy and engage in on an ongoing basis? Check all that apply.
Action/Outdoor Sports (Snowboarding, Skateboarding, Rock Climbing, etc.)
Arts (Drawing/Painting/Sculpting)
Auto Mechanics / Tuning
Blogging
Charity Work/Volunteering/Community Building
DIY Technology (i.e. build an amp, modify your computer).
Please describe:
Enjoying Nature (Nature Walks, Interest in Environment)
Film Appreciation, Film Making
Music (Playing in a Band, DJing, etc.)
Playing video games
Team Sports (Basketball, Baseball, etc.)
Technology / Programming
Please enter any other activities you are into:
Other 1:
Other 2:
Other 3:
6.
Do you use any of the following online community networks?
Myspace
Facebook
Youtube
Flickr
Twitter
LinkedIn
Pownce
Other
Please share with us any social networking profiles you have:
7.
List your top 3 favorite web sites.
8.
Do you write your own blog?
yes
no
Do you contribute to other blogs?
yes
no
If yes, can you share an example (URL)?
9.
Is there anything else you would like to share with us for consideration in reviewing your application?
10.
I agree to the Terms and Conditions
I agree to the above Terms and Conditions
11.
I agree to the Privacy Policy
I agree to the above Privacy Policy
12.
I agree to the Code of Conduct
I agree to the above Code of Conduct
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