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Gender Selection Survey Part 1: The Bare Basics

1. Date of Conception:

   (Month) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   (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  

2. Baby's Birth Date:

   (Month) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   (Year) 2010 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 Or due date, if you're still pregnant.

3. Did you specifically try to have a boy or a girl?

   Yes, tried for a boy
   Yes, tried for a girl
   Nope, didn't specifically try for either

4. Is your baby a boy or a girl?

   It's a boy!
   
   It's a girl!
   
   Still pregnant, I don't know yet!
   Please check here if you are still pregnant, even if you have been told your baby's gender at an ultrasound. If you have absolute proof of gender (amnio or CVS results) then go ahead and check boy or girl.
   
   It's twins, triplets, or more!
   Check here for multiples, whether you're still pregnant or not, and enter genders on the next page. (Don't worry, if you happen to find out later that you have been blessed with multiples, you can come back here and change it!)

5. How old were you and the father at the time of conception?

    Mother's age at time of conception 
    Father's age at time of conception 

6. This was your 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th or more  pregnancy.

7. How many boys and girls did you have before this pregnancy?

   (Number of Boys) No Boys 1 Boy 2 Boys 3 Boys 4 Boys 5 Boys 6 Boys 7 Boys 8 Boys 9 Boys 10 or more boys!    (Number of Girls) No Girls 1 Girl 2 Girls 3 Girls 4 Girls 5 Girls 6 Girls 7 Girls 8 Girls 9 Girls 10 or more Girls!

8. Where did conception occur? (Geographically, that is!)

   Country:
   United States Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bolivia Bonaire Bosnia Botswana Brazil British Virgin Isles Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Curacao Cyprus Czech Republic Dem Rep of Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Holland Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosrae Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Madeira Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar N. Mariana Islands Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norfolk Island Northern Ireland Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Ponape Portugal Puerto Rico Qatar Reunion Romania Rota Russia Rwanda Saba Saipan San Marino Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands South Africa South Korea Spain Sri Lanka St. Vincent/Grenadine St. Barthelemy St. Christopher St. Croix St. Eustatius St. John St. Kitts and Nevis St. Lucia St. Maarten St. Martin St. Thomas Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Tinian Togo Tonga Tortola Trinidad and Tobago Truk Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Union Island United Arab Emirates United Kingdom United States Uruguay US Virgin Islands Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Gorda Wake Island Wales Wallis and Futuna Islands Western Samoa Yap Yemen Zambia Zimbabwe Please tell me if your country isn't listed!

   US state, US territory, or Canadian province:
   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ----------------------------------------------- American Samoa Guam Marshall Islands Micronesia Northern Mariana Islands Palau Puerto Rico Virgin Islands ----------------------------------------------- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory

9. Would you like to display a board name or alias with your survey?

   The survey is completely anonymous, but if you want to be recognized by your online friends or your dear board buddies, you may enter a board name, alias, first name only, or some other kind of identifier that will be displayed with your survey. Do not enter your real full name!
   Alias or board name: