Mom Ambassador Application Survey
Questions marked with an asterisk (*) are mandatory.

Thank you for your interest in becoming a Moms Meet Mom Ambassador! Our Mom Ambassadors are selected based on a number of criteria. Please take your time to answer the following questions and determine whether the Mom Ambassador program is right for you. The survey should take 8-10 minutes to complete.

Rest assured that all information you provide will be kept in strict confidence. We do not share your information with any third party.

1

* What is your name and contact information?

Note: The Mom Ambassador program is currently available in the United States only. If you reside outside the United States and would be interested in participating, please email us at momambassadors@greenmomsmeet.com.

Mailing address must be a physical address and not a PO box.

Name
Telephone
Address
Address (continued)
City/Town
State
Zip code
Email address
2
* How did you hear about Moms Meet?
Kiwimagonline.com
Web search
Another Mom Ambassador
Friend
Relative
Facebook
Twitter
Someone reached out to me through Meetup.com
Website or blog
Other, please specify
3
If you heard about Moms Meet through a website or blog, please specify the name and/or URL.
4
* What is your age?
Under 18
19-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60 or over
5
* Are you employed?
Yes, I work full-time outside of the home.
Yes, I work part-time outside of the home.
Yes, I work from home.
I am not employed.
6
* What is your level of education?
High school degree
Completed some college
College degree
Graduate or professional degree
7
* What is your annual household income?
Less than $40,000
$41,000 to $75,00
$75,001 to $99,99
$100,000 to $150,00
$150,001 to $250,00
$250,001 or more
Decline to answer
8
* How many children do you have?
1
2
3
4
5 or more
Expecting my first
None
9
* What are the ages of your children?
Newborn
6 - 23 months
2-4
5-7
8-10
11-13
14-17
10
* Are you currently pregnant or planning to become pregnant in the next year?
Yes
No
11
* Do you have any pets?
Yes, a dog.
Yes, a cat.
No
Yes, other
12
* We'd like to learn more about your interest in and experience with green living. By "green", we mean natural, organic, environmentally and socially responsible living. How would you rate your current involvement with this type of lifestyle?
I am very involved
I am somewhat involved
I am not involved but want to be
I am not involved and do not want to be
13
* Which, if any, of the following do you currently use?
Natural, organic, or cloth diapers
Natural, organic, or homemade baby food
Natural, organic, or plant-based cleaning products
Natural, organic, or plant-based personal care products
Natural or organic pet food or pet products
Allergy-free foods
Gluten-free foods
Natural or organic foods
Natural or organic vitamins and supplements
None of the above
14
* Do you exercise? If so, do you:
Practice yoga
Run
Bike
Practice Pilates
Go to a gym
Walk
Attend a mom exercise class
I do not exercise
Other, please specify
15
* Which social networking sites do you belong to, if any?
Facebook
Twitter
Linkedin
Youtube
Myspace
Foursquare
CafeMom
Meetup
Other (please specify)
16
* Do you have a blog?
Yes
No
If yes, what is the URL?
17
Which, if any, of the following parenting websites do you regularly visit?
BabyCenter
BabyZone
KIWI - KiwiMagOnline
Mothering
Parents
Earth's Best
WebMD
Parenting
Family Fun
iVillage
Ask Dr. Sears
Cafemom
DrGreene
Whole Foods
Cookie
Babble
Other, please specify
18
What magazines have you read in the past two months?
KIWI
Parenting
Parents
Family Fun
Better Home and Gardens
Family Circle
American Baby
Wonder Time
Fit Pregnancy
Lamaze
Natural Health
Whole Living - formerly Body & Soul
Real Simple
Vegetarian Times
Eating Well
Organic Gardening
Other, please specify
19
* What do you hope to gain most from being a Mom Ambassador?
An opportunity for my friends and I to get together and talk
A way to meet new friends who are moms
A way to learn more about raising healthier kids
A way to learn more about living a green lifestyle
A way to share what I know with others
A way to use my leadership skills while not in the workforce
A way to sample products or services from sponsoring companies
Other, please specify
20
* Do you currently lead a moms group?
Yes, I lead a moms group.
Not yet, but I am interested in starting one.
No, but I participate in one and would like to lead a Moms Meet group.