Kawiteno Member Survey
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1. Default Section
1
. Please provide your contact information.
Please provide your contact information.
Name:
Company:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Email Address:
Phone Number:
2
. Your spouse's name?
Your spouse's name?
3
. List Children & Ages
List Children & Ages
4
. What is your profession?
What is your profession?
5
. Are currently a registered member?
Are currently a registered member?
Yes
No
6
. If so, for how long have you been a member?
If so, for how long have you been a member?
7
. Which barrio in Kawit are you from?
Which barrio in Kawit are you from?
8
. Which funtions do you regularly attend?
You can choose more than one.
Which funtions do you regularly attend? You can choose more than one.
Fiesta
Maytinis
Karakol sa Dagat
Induction Ball
Fund Raisers
Other sponsored events
9
. What new functions/activites would you like to see in the future?
What new functions/activites would you like to see in the future?
10
. What are your personal interests?
What are your personal interests?
Sports?
Hobbies?
Talents?
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