III. What limits should be placed upon public behavior of homosexuals?

IV. What specific rights should homosexuals have?

V. What form should the proposed "Bill" have?

VI. How should it be used when completed?

Age How long

Male

Female

Heterosexually married

Children

Divorced.

How Long

How Long

Length of each

Homosexually married

Previous such connections

Your Education: Grammar school:

High School_____

College

Degrees

Fields of specialization

Present Employment (type).

How Long

Previous Employment (type)

How long

Do you rent

Own your own home

How long have you

lived there

How long at former address

VII. Will you help to prepare it?

L

VIII. Do you plan to attend?the Midwinter Institute in January?

IX. Have you a preference as to the work activity you would like during the sessions?

To describe the economic status of those replying, what is your monthly

Present state of your health

income

Have you ever had serious illness

What

Have you ever been under a psychiatrist's or psychoanalyst's care

How long

In a mental institution

How long

CONCERNING THE FOLLOWING QUESTIONS...

In documenting the Institute's work it will help to know something about the persons who favor particular approaches to such a "Bill." Answers to the following questions are optional and will be used for tabulations only. No identification will be made between personal data submitted and the attitudes expressed other than for statistical purposes.

Do you smoke

In what way..

Has drinking ever been a problem

Are you active in homophile work

In Civic or Philanthropic work

How long

Which

i