Advertiser Survey

Your Name:
Agency:
Phone number:
Email address:
Client:
Birthday:
Alma mater:
If you're a sports fan, what are your favorite teams?
Do you play golf? Yes
If not, would you like to learn? Yes
All-Time Favorite band(s):
Favorite Area Spa(s):
Favorite Treatment(s):
Favorite Area Restaurant(s):
Favorite Ethnic Food(s):
Do you have children? Yes
If yes, what are their names and ages?
Please check "Yes" on any of the following activities that interest you.
Private Group Cooking Class
Broadway Show
Private Chocolate Tasting
Private Wine Tasting
Professional Sporting Events
Live concerts
Niketown: Customize Your Sneakers
MAC Makeover/Products
Other