Appendix A. Motorcycle Focus Group
 Telephone Screening Form

Pacific Institute for Research and Evaluation is conducting a focus group study to determine what motorcyclists do to avoid drinking and riding while intoxicated. We want to include people in our study who have many different motorcycling backgrounds. We would like to ask you a few questions to understand your motorcycling background. Please answer all questions honestly, there are no right or wrong answers, and your responses will be kept confidential. 

1. Name 
   
   
2. Phone number where we can reach you 
   
   
3. What is the best time to reach you? 
   
   
4. E-mail Address 
   
   
5. How did you find out about this project? 
   
   
6. Age 
   
   
7. Do you consider yourself: 
1. White 
2. African American 
3. Asian 
4. Native American 
5. Pacific Islander 
6. Hispanic / Latino 
7. Other 
   
   
8. Years of riding experience
   
   
9. How often do you ride? 
1. daily 
2. several times/week 
3. several times/month 
4. several times/year 
   
   
10. Do you ride: (circle all that apply) 
1. to work/school 
2. to after work/school activities 
3. for recreation - alone 
4. for recreation - in groups 
   
   
11. What groups do you ride with? 
    
    
12. Do you drink alcohol? Yes / No
    
    
13. When was the last time you rode after drinking what you now think was probably too much to drink and ride safely? 
1. within the last month 
2. within the last 6 months 
3. within the last year 
4. more than a year ago 
5. never
   
   
14. Have you ever been convicted of driving or riding while intoxicated? Yes / No
    
    
15. Are you available on: 
1. (Fill in Month and Date), 2001 
2. (Fill in Month and Date), 2001
    
   
16. Are you available in the: 
1. afternoon
2. evening

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