/>
     
First Name *   Last Name *
 
     
Date of birth *   Gender *
 
MaleFemale
     
Email address *   Mobile number *
 
     
Education *   Profession *
 
     
Address
     
State *   City *
 
     
Pincode *   Language spoken *
 
     
Are you happy in life?*
  Most often Quite often Sometimes Rarely Not at all
 
What are the reasons for your unhapiness *
  Health Job/Business Family/Relatives Friends/Society Nation Self
 
I am troubled by *
  My own mind Other's Attitude Circumstances State of the nation
 
My worry is *
  Financial Health Future Changing Culture Society
 
My Happiness is related with my country's Progress *
  Very Much Partially Not at all
 
Are you satisfied or dissatisfied with the current state of the Country? *
  Fully Satisfied Somewhat Satisfied Somewhat Dissatisfied Fully Dissatisfied
 
Have you seriously been affected by Corruption *
  Yes No
 
Have you seriously been affected by Price Rise *
  Yes No
 
How would you rate the economic situation of the country *
  Very Good Good Average Poor Very Poor
 
What will be your single most important criteria for you when you vote in 2014 *
  Local Candidate Party Prime Ministerial Candidate of a party
 
I would like to Volunteer for a Better India and give one hour in service *
  Yes No
 
Are you registered to vote? *
  Yes No
 
If yes please provide your Voter ID card number
 
Have you attended any of the Art Of Living workshops? *
  Yes No
 
I do some spiritual practises *
  Not yet Started Intend to Not interested I do
 
I understand that voting is my fundamental right and I pledge to definitely vote in the upcoming      elections *
  I Agree
 
I will make an informed decision and will vote for the right candidate for a strong and stable      government *
  I Agree