1. First Name

2. Last name

3. Will you be attending Sampler Day 2015?

4. When you were last here on campus, what did you do? Please choose all that apply.

5. Email Address

6. 5-digit Zip Code

7. Which topics are you most interested in sampling?

8. Are you planning to take a Continuing Education course in the spring?

9. Please check all ways you heard about Sampler Day

10. If you would like this survey to serve as your registration for the Sampler Day event and as your entry into the raffle, please indicate your full birthdate below (Sample: Feb. 14, 1950)