Please do not fill out multiples of this survey. Thank you for your time.

Did you know... in America motor vehicle crashes are the number killer of people up to the age of 34.
Did you know... if you weigh 150 lbs and collide with another object at 65 miles per hour, the overall crash force will be 9,750 lbs, a deadly equation for an unrestrained occupant.
Did you know... safety belts saves lives.

Information. Please provide...

Hometown
State
Age

1. Do you wear your safety belt while driving a vehicle?

Yes No

2. Do you wear your safety belt while riding in a vehicle?

Yes No

3. Have you or someone you know been injured or killed in a vehicle crash?

Yes No

4. Do you or someone in your family own a pick-up truck?

Yes No

5. Did you know it was legal in the State of Georgia to drive or ride in a pick-up truck without wearing a safety belt if you are over 18-years of age?

Yes No

6. Do you support legislation requiring safety belt usage to drive or ride in a pick-up truck in the State of Georgia?

Yes No

7. Why or why not?

8. Comments

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