We Want Your Feedback

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* 1. Member's Name

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* 2. Membership No. (e.g. A123400 / A123401)

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* 3. Email Address

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* 5. Date/Time Visited

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* 6. Name of Staff

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* 7. Feedback Type

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* 8. Service

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* 9. Quality

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* 10. Menu item feedback or equivalent

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* 11. Other Feedback

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* 12. Would you like to be contacted regarding your feedback?

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